Treatment For Denture Patients

Denture patients often develop obstructive sleep apnea, 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.  

Recently Dr. Summer has developed two new new oral appliance treatments for obstructive sleep apnea in denture patients - a tongue holding device and a soft palate elevator.  These devices are built onto denture base plates (dentures without teeth) and worn during sleep to prevent the soft tissues of the throat from forming a plug that obstructs 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, the ongoing clinical study for FDA clearance of the tongue holding device involves 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 grips the tongue body between upper and lower tongue gripping surfaces composed of thousands of tiny forward slanted bristles, like tongue velcro.  In denture wearers, the tongue is held up against the upper denture base plate, which is the most stable structure in the area.  The tongue holding technology is described in, MULTI-LEVEL TREATMENT OF SLEEP APNEA as summarized under this tab and detailed 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 fully seated on the gums by the tongue functioning like a big long cushion.  Very little retention is required in the denture base plates, therefore 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, because that 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.  

In most denture wearers, resilient mounting of one of the tongue gripping surfaces to produce a cushioned grip is unnecessary, because the vertical dimension (height) of the appliance produces enough passive stretch of the jaw closing muscles to hold the tongue comfortably, and it can be easily controlled in the design of the appliance.  If a cushioned grip is needed to prevent tongue release during submaximal opening, the lower tongue gripping surface, (rather than the upper tongue gripping surface in dentate patients), is attached to the lower denture base plate by a polyester mesh anterior tether and a pair of 3/8” long 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 elastics bias the lower tongue gripping surface continually upward into the underside of the tongue.  The bias 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.