Comprehensive Oral Appliance Treatment For Sleep Apnea

Obstructive sleep apnea occurs when people choke on their tongues during sleep.  Dentists make a variety of different oral appliances to treat obstructive sleep apnea, and they are tolerated by patients much better than CPAP; but they almost all work just by advancing the mandible (the lower jawbone).  Advancing the mandible creates space in front of the tongue and thereby allows it to rest in a more forward (advanced) position; but advancing the mandible cannot draw the tongue forward into that new space, because the tongue and mandible are only attached by muscles, which naturally lose most of their tonus during sleep. As a result, they only cure the problem in about half of the patients treated.

To relieve sleep apnea in the people with ineffective mandibular advancement appliances and in people who wear dentures, Dr. Summer has developed new technologies that can be added to these oral appliances to also control the soft tissues that produce the actual obstruction. A tongue holding device holds the tongue and tongue base forward together with the mandible so it cannot drop back into the pharynx, while a soft palate elevator draws the end of the soft palate forward and upward away from obstruction in the nasopharynx.  These components are described in detail in the file entitled, MULTI-LEVEL TREAMENT OF OBSTRUCTIVE SLEEP APNEA under the tab FOR DOCTORS.

The pilot study for the FDA submission used patients with a normal healthy set of teeth (dentate patients).  The new study, beginning fall 2023, will involve only denture patients who have obstructive sleep apnea. They will receive a new denture baseplate (no teeth) containing a tongue holding device and also a soft palate elevator if needed.  Multi-night home sleep testing will be used to guide treatment.  

Many dentists now make mandibular advancement appliances for treatment of obstructive sleep apnea, but effective treatment for obstructive sleep apnea should consider both short-term and long-term effects.  Therefore, while short-term relief can be obtained by elevating the soft palate and advancing the mandible and tongue; the slow facial growth of adulthood should also be redirected anteriorly to gradually improve the airway by including functional orthodontic mechanics into the design of the mandibular advancement appliance.