Oral Appliance Study Displays Success

We never needed further proof of the success of oral appliance therapy, but it doesn’t hurt to hear more about it and reaffirm its input. In this recent study, we can see just how successful Narval appliances are in the treatment of sleep apnea. Let’s take a look…

The Background

In this study, mandibular repositioning devices (MRDs) are usually recommended as the first form of therapy for patients suffering from mild to moderate obstructive sleep apnea (OSA). Unfortunately, though, data on the long-term efficacy of MRDs hasn’t been readily available. This is not only true for patients with OSA who are noncompliant with CPAP, but also in those with more severe OSA.

To get a better understanding of the success of oral appliances, such as MRDs and the Narval appliance, the ORCADES study[1] aimed to determine the long-term efficiency and tolerability of two custom-made Narval MRDs for the treatment of OSA patients. The study was completed over a three to six month period of time.

Eligible patients suffering from OSA who also refused or were CPAP noncompliant, were studied. The outcomes were measured after gradual mandibular advancement titration, which included AHI, oxygen saturation, sleepiness, symptoms, quality of life, side effects and compliance. And, drumroll please! Here are the results…

The Results

Of a total of 369 patients involved in the study, overall MRD treatment was successful in approximately 76%. Additionally, complete response to treatment with MRDs was achieved in 64% of participants.

The study also treated severe OSA with MRDs, and about 60% of the participants were effectively treated with about 38% having completed symptoms resolution. As a result, the use of MRDs in the treatment of sleep apnea significantly decreased a person’s sleepiness, and eliminated symptoms while improving their quality of life. Treatment with MRDs were very well tolerated and compliance was at its highest rate.

Custom-made appliances, such as Narval MRDs, are effective forms of treatment for mild to severe OSA, as well as for patients who are CPAP noncompliant. Keep this study in mind when informing your patients of proper treatment options, as well as sharing with referring doctors.

 

 

 

 

[1]  Vecchierini, M. F., Attali, V., Collet, J. M., d’Ortho, M. P., El Chater, P., Kerbrat, J. B., … & Mullens, E. (2016). A custom-made mandibular repositioning device for obstructive sleep apnoea–hypopnoea syndrome: the ORCADES study. Sleep Medicine, 19, 131-140.

The Painful Truth About TMD and How to Help

As you already know, temporomandibular joint disorders (TMD) refer to a cluster of conditions that are often characterized by pain in the temporomandibular joint (TMJ) or its surrounding tissues. The surrounding tissues might include the neck, head and even shoulders. Conditions involving the TMJ are so common among the adult population that up to 75 percent show at least one sign of TMD upon examination. Let’s take a look at some of the instances in which TMD can cause further complications and how to educate your patients.

Further Complications

Evidence continues to be available about TMD and how it can be worsened by other conditions. Today, it has been shown that anxiety, stress, and other emotional disturbances may worsen TMD. Some of the common signs of TMD include:

  • Jaw pain
  • Limited or painful jaw movements
  • Headaches
  • Neck pain or stiffness
  • Clicking or grating within the joint
  • Inability to open mouth without pain

It has been shown that about 55 percent of patients with chronic headaches who were referred to a neurologist actually have signs of TMD. Without the education on TMD, signs and symptoms often go overlooked and no treatment can be found.

As a dentist, you can put an end to the misdiagnosis of TMD by completing further education. You can also educate your patients on self-care techniques and referral for non-invasive treatment should be considered [1].

Improvement with Treatment

Signs and symptoms of TMD improve over time with at-home care, and with oral appliance therapy from the dental office. Previous studies have even show that as many as 50% of patients improve in one year and 85% improve completely in three years. Encourage conservative treatment before any invasive options are considered. It is important to treat your patients properly without causing further complications.

Contact my office to learn more about TMD and available treatment options, as well as upcoming lectures for continuing your education.

 

 

 

 

1. Lindsay, J. (2016). TMJ Disorder-The Painful (but Helpful) Truth. Pain.

TMD Could be Interrupting Our Patients’ Sleep

Approximately one in every four people who regularly visit their dentist has a condition called bruxism, which is an involuntary movement of the jaws when a person is sleeping. And, about 80% of those who do grind their teeth each night are unaware they are doing it. It can happen occasionally to some people without causing any severe damage, while others it can cause a lot of harm to their teeth. Unfortunately, though, those who experience regular teeth grinding face the possibility of dental problems and sleep disorders. One complication that can arise is temporomandibular joint disorder (TMD).

What is TMD?

TMD is a problem occurring within the jaw, jaw joint and the surrounding tissues. The TMJ is a hinge joint which attaches the lower jaw to the temporal bone of the skull found in front of the ear on the sides of the head, which allows for jaw movement and enables yawning, talking and chewing. When teeth grinding occurs at night, the TMJ can become damaged from the pressure causing a chain reaction to the surrounding tissues resulting in pain, injury and or joint degeneration.

The Sleep Apnea and TMD Connection

Approximately 75% of people with TMD have signs that suggest a sleep breathing disorder, such as sleep apnea. A narrow upper arch of teeth is 90% predictive of OSA and a retruded chin in 70% predictive of OSA.

In other words, teeth grinding and TMD can affect more than just the jaw–it can be an underlying cause for sleep apnea and other sleep disorders. The tongue which is attached to the lower jaw acts as a pad when the jaw is not aligned under normal circumstances. When TMD is present, it is possible for the jaw to move and for it to become misaligned, which affects the bite and general size of the mouth. This change in size can result in the inability of the mouth to properly accommodate the tongue.

When less space is available, the tendency is for the tongue to fall to the back of the mouth, which, in turn, creates a blockage in the air pathway. This obstruction then leads to episodes of pauses in breath or shallow breathing known as sleep apnea.

To learn more about TMD and the connection with sleep apnea, feel free to contact my office or attend an upcoming lecture.

Teaching Dental Sleep Medicine in Dental School at West Virginia University

Previously we have discussed the need to incorporate dental sleep medicine courses into the curriculum at dental schools. While this continues to be an area that we need to focus on, I have some exciting news to share with you all. To my knowledge, the first school where the dean is proactive in incorporating dental sleep medicine (DSM) education is West Virginia University School of Dentistry.

Beginning in the first year of dental school, Dean Borgia of West Virginia University ensures students can start receiving classes in DSM. And, to help keep students informed, I have joined forces to provide courses on DSM and other areas. Teaching

My Time Teaching at WVU

Topics are covered at West Virginia University as they cover sections in Basic Science. When students complete head and neck anatomy, I came in to visit and teach about Airway Anatomy as it relates to sleep apnea. Understanding the airway and how it can affect a patient’s sleeping patterns due to sleep apnea, and other sleep disordered breathing conditions, is vital in maintaining your patients’ health and improving service offerings.

Next, when students’ classes covered respiration in physiology, I came in again to discuss sleep physiology. There are two types of sleep, non-rapid eye movement (NREM) and rapid eye movement (REM). By understanding these types of sleep, and their role in sleep apnea, as well as other areas, students can continue to learn the importance of DSM and caring for their patients.

This occurs each time students reach a place in their learning where dental sleep medicine come into the picture. By providing these added courses, we can pave the way for our students to begin their dental careers with more knowledge than ever before. And, while they will still need to complete more education each year to remain up-to-date, the dean, a few of my colleagues  and myself are able to get them prepared for the future.

Providing advanced classes in dental sleep medicine at our Universities should be a requirement for all dental schools. I am glad West Virginia University’s School of Dentistry Dean has taken that next step in providing classes at each phase of learning. To learn more about my upcoming lectures, and where I might be next, please visit my Upcoming Lectures page.