Treatment For Denture Patients

Denture patients develop obstructive sleep apnea more commonly and severely than people with a normal set of teeth, because they have no bite platform against which they can prop their lower jawbone to prevent it from dropping down and back into the space needed for airway passage through the pharynx (throat). However, denture patients cannot wear the mandibular advancement appliances that are used to treat obstructive sleep apnea in people with teeth, because their gums cannot tolerate the pressure required to push the lower jawbone forward off the upper jawbone.  Therefore, until now, their only options have been CPAP or surgery.

Now denture patients have a non-surgical alternative. Dr. Summer has developed and successfully tested a tongue holding device and a soft palate elevator that can be built onto denture base plates (dentures without teeth) and worn during sleep to prevent the soft tissues of the throat from plugging the airway. The soft palate elevator has already been FDA approved.  The tongue holding device was found safe and effective in patients with normal teeth in a clinical study for the FDA, but not yet in denture patients.  Therefore, we are conducting a clinical study involving denture patients with untreated obstructive sleep apnea.  Those who qualify will receive a tongue holding device along with before and after home sleep testing to evaluate its effectiveness.  If the tongue holding is not effective, a soft palate elevator will be added, followed by another home sleep test.  

The tongue holding device holds the tongue body between upper and lower tongue gripping surfaces composed of thousands of tiny bristles, like tongue velcro, in sheets that are molded to fit your mouth.  The tiny bristles are all slanted forward at a 45 degree angle to prevent the tongue from dropping back into the pharynx. The tongue holding technology is summarized below and described in detail in the file entitled, MULTI-LEVEL TREATMENT OF SLEEP APNEA under the FOR DOCTORS tab. 

Tongue holding is especially effective in denture wearers; because the tongue gripping surfaces can extend almost all the way to the cheeks, and the denture base plates supporting them are held comfortably seated on the gums by the tongue functioning like a big long cushion between them. Therefore, very little retention is required in the denture base plates, and they can even be effective in people who cannot wear dentures for eating.  However, the goal of the tongue holding treatment in denture wearers is not advancement, which would apply pressure to the gums.  The goal of treatment is just to hold the tongue against the upper denture base plate to prevent it from dropping back into the pharynx.  

To create the cushioned grip that ensures comfort and prevents tongue release during submaximal opening, the lower tongue gripping surface, (rather than the upper tongue gripping surface in dentate patients), is spring-loaded to push the back of the tongue upward against the upper denture base rather than downward against the mandible.  The anterior end of the lower tongue gripping surface is attached to the lower denture base plate by a polyester mesh tether, and the posterior ends of the lower tongue gripping surface are continuously biased upward into the underside of the tongue by a pair of torsion springs or orthodontic elastics on each side that connect a cleat on the posterior portion of the lingual flange of the lower tongue gripping surface with a ball clasp on the buccal side of the posterior portion of the lower denture base plate, as shown below.  The bias from the elastics is maintained until the cleats reach the same plane as the bite table.  Any further opening releases the tongue.  The release point is controlled by the location of the cleats on the lingual flanges.

  

   BOTTOM ENDS OF ELASTICS ON CLEATS        TOP ENDS OF ELASTICS ON BALL CLASPS        ELASTICS SUSPEND LOWER TONGUE GRIPPING SURFACE  

If tongue holding is insufficient to eliminate the obstructive sleep apnea in a denture wearer, a soft palate elevator is attached to the back of the upper denture base plate, followed by another home sleep test.  The soft palate elevator is described in detail in MULTILEVEL ORAL APPLIANCE TREATMENT in detail under the FOR DOCTORS tab.