Dennis R. Bailey

Oral Appliances for Sleep Breathing Disorders

Oral appliances gained acceptance over the last decade and, at the same time, have been proven to be an effective way to manage sleep breathing disorders. Their role has become more acceptable since the first practice parameters paper was published in 1995. Over a 10-year period since then, they have gained an even larger and expanded role. This has occurred because of an increased number of articles with a higher level of evidence relative to efficacy, they are more widely recognized by the sleep medicine and physician community, and there are improved outcomes associated with their use. In the future, oral appliances will be more recognized and accepted. This will occur as two key areas emerge in the future: studies that validate the use of oral appliances, including long-term studies, and the role of oral appliances as part of combined therapy with positive airway pressure (PAP) devices.

Screening and Comprehensive Evaluation for Sleep Related Breathing Disorders

The dentist is well positioned to screen for patients at risk for a sleep disorders, most often a sleep related breathing disorder, and when adequately trained, can treat those diagnosed with sleep apnea using an oral appliance. This treatment requires some degree of training to be able to recognize the symptoms related to the more common sleep disorders. The dentist must determine if the patient is at risk for a sleep disorder through the use of screening questionnaires, reviewing the health history, and additional questioning of the patient.

The History of Sleep Medicine

Sleep medicine as it is known today actually started as research and scientific study, not as clinical medicine. When one considers that sleep medicine today is in its infancy, it is obvious that there is much more to learn. The history of sleep dates back to the 1880s. However, the most significant developments that moved sleep forward into the practice of medicine, and eventually dentistry, occurred from the 1950s on. This article explores the highlights of the history of sleep and sleep medicine.

Oral Appliances for the Management of Obstructive Sleep Apnea

The use of oral appliances has been more widely accepted over the last decade. Despite the fact that the availability of these devices is not widely known, the use of them as for a first-line therapy and as an option to CPAP or surgery is growing. In like manner the evidence to support the use of oral appliances as a viable treatment option for patients with sleep apnea or who may only snore is only going to become more compelling as it relates to the use of oral appliances. One of the key issues surrounding the decision to use an oral appliance, have surgery or to use CPAP is not just which will be more effective but which therapy is likely to proved the best long term benefit. When considering a decision to use CPAP or an oral appliance the need to assess compliance and adherence is paramount. After all, what matters most is that the patient is motivated to manage the sleep apnea on an ongoing, regular basis in an effort to avoid the onset of health risks related to sleep apnea. Oral appliances offer the patient this option along with convenience and in many cases an improved quality of life.