Treatment For Denture Patients

Denture patients are especially susceptible to obstructive sleep apnea, because they have no bite platform against which they can prop their lower jawbone to prevent it from dragging the tongue base down and back into the throat. Dentists now treat obstructive apnea successfully in many cases with mandibular advancement appliances, but denture patients can't wear them, because their gums cannot tolerate the pressure required to push the lower jawbone forward off the upper jawbone. Implants have been used to enable some edentulous people to undergo some mild mandibular advancement, but the pressures can endanger the implants. 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 new mechanisms that can be added to denture base plates (dentures without teeth) and worn during sleep to prevent the soft tissues of the throat from plugging the airway. The tongue is held to prevent it from falling back into the pharynx, and the distal end of the soft palate (uvula) is drawn forward to prevent it from contributing to the obstruction and snoring in the nasopharynx. The soft palate elevator has already been FDA cleared, K 211481. The tongue holding device was found safe and effective in patients with natural 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.  

Tongue holding is especially effective in denture wearers; because the tongue gripping surfaces can extend almost all the way to the cheeks, and the entire tongue body keeps the denture base plates comfortably seated like a giant cushion, so they require very little retention. They can even extend buccally far beyond the edentulous ridges, because they don't have to withstand asymmetrical chewing forces. They can even be worn during sleep by some people who cannot wear dentures during the day. The entire tongue body is held between specialized upper and lower tongue gripping surfaces which each contain 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. 

                                      UPPER TONGUE GRIPPING SURFACE ON DENTURE BASE PLATE

The photos above show an upper tongue gripping surface mounted on an upper denture base plate. As seen in the right side photo above, the upper tongue gripping surface is spring mounted to prevent its grip from becoming interrupted when the mouth opens part way or makes other submaximal movements, like in bruxism. During partial mouth opening, the spring pushes lightly down on the upper tongue gripping surface to keep it in contact with the surface of the tongue, as shown from left to right below.

                                  GRIP IS MAINTAINED BY SPRING DURING PARTIAL OPENING

The upper tongue gripping surface is split into two segments that move independently to accommodate the wave of tongue muscle contraction that occurs during swallowing. The two segments are connected by lightweight torsion springs as shown below left, then attached to the upper denture base plate by means of a length of stainless steel tubing passing through the coils, shown below right. 

  

                                                      SEGMENTED UPPER TONGUE GRIPPING SURFACE

On the left side below, the upper tongue gripping surface is passive. In the middle photo below, the first stage of the swallow pushes upward on the front of the tongue. In the right side photo below, the second stage of the swallow pushes upward on the back of the tongue base.

  

                         UPPER TONGUE GRIPPING SURFACE SPLIT TO FACILITATE SWALLOWING

 In the photos of a lower denture base plate below, the narrow flat occlusal table, which supports the lower tongue gripping surface, extends a few mm beyond the edentulous ridge on both sides. 

 

The lower tongue gripping surface is provided in the shape of the underside of the tongue, but it can also be reshaped to better fit the lower denture base plate by dipping it in boiling water and pressing it down against the base plate. 

   

                                         LOWER TONGUE GRIPPING SURFACE ON DENTURE BASE PLATE

The lower tongue gripping surface can be just bonded to the lower base plate, or it can be "spring loaded" to help raise the back of the tongue and enhance the cushioned grip that ensures comfort and prevents tongue release during submaximal opening. The spring used is one long piece of orthodontic spring hard wire that pushes the lower tongue gripping surface continuously upward into the underside of the tongue, as shown below. 

 

                                                          LOWER TONGUE GRIPPING SURFACE SPRING LOADED

The tongue is gripped between upper and lower tongue gripping surfaces as shown from front and back below.

  

                                           FRONT VIEW                                               REAR VIEW                                                     

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.

                                       SOFT PALATE ELEVATOR ADDED TO UPPER DENTURE BASE PLATE

The soft palate elevator and tongue holding device are added separately for the purposes of the study we are now conducting, but clinically they work best together, because the forces they apply balance each other out. The light force pushing upward on the soft palate elevator applies the same amount of reciprocal force downward on the back of the upper denture base plate, which is simultaneously pushed upward by the pressure of the tongue. The separation of the soft tissues (the soft palate moving up and forward while the tongue base is pushed down and forward), as seen below, creates space for airway flow between them.