Treatment For Denture Patients
SUMMARY - Denture patients are especially prone to obstructive sleep apnea, because they have no bite platform against which they can prop their mandible to prevent it from pushing the tongue base down and back into the throat. Dentists treat obstructive apnea 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. Therefore, until now, their only options have been CPAP or surgery.
Now denture patients have new non-surgical alternatives. Dr. Summer has developed two 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 soft palate elevator has already been FDA cleared, K 222127. 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 does not eliminate the problem, a soft palate elevator will be added, followed by another home sleep test. Implants used to hold dentures during the day improve the stability of the base plates without applying damaging forces to the implants, because the implants are not gripped in any way but just used as overdenture supports.
THE TONGUE HOLDING DEVICE - Holds the entire tongue body and the lateral borders of the tongue base between specialized upper and lower tongue gripping plates, which each contain thousands of tiny plastic pin points, which are packed so closely together that they feel like fuzz. Also the pin points are all slanted forward at a 45 degree angle to prevent the tongue from dropping back into the pharynx. Sheet of this "tongue velcro" are formed into anatomically shaped tongue gripping plates, which can be reshaped by dipping them in boiling water if necessary, before mounting them on the denture base plates in a position that fits the patient's tongue in its target treatment position.
UPPER TONGUE GRIPPING PLATE ON DENTURE BASE PLATE
The tongue gripping plates can be "spring mounted" on the denture base plates to provide a cushioned grip that cannot be interrupted by the small mouth movements that occur during normal sleep. The photos above show an upper tongue gripping plate spring mounted on an upper denture base plate. During partial opening, the spring maintains a very gentle push down on the upper tongue gripping plate 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 plate is split into two segments that move independently to accommodate the wave of muscle contraction that passes along the tongue during swallowing. The two segments are connected by lightweight torsion springs as shown below left, then attached to the upper denture base plate by stainless steel tubing passing through the coils, shown below right.
SEGMENTED UPPER TONGUE GRIPPING PLATE
On the left side below, the upper tongue gripping plate 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.
UPPER TONGUE GRIPPING PLATE 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 plate, extends a few mm beyond the edentulous ridge on both sides. Because the base plates are not asymmetrically loaded in chewing, they can extend far beyond the edentulous ridges.
LOWER TONGUE GRIPPING PLATE ON DENTURE BASE PLATE
The photos below show a lower tongue gripping plate tethered anteriorly by a length of flexible polyester mesh and mounted with a spring to help raise the back of the tongue and enhance the cushioned grip. The spring used to mount the lower tongue gripping plate is one long piece of orthodontic spring hard wire that pushes the back end of the plate continuously upward into the underside of the tongue, as shown below.
LOWER TONGUE GRIPPING PLATE SPRING LOADED
The tongue is gripped between upper and lower tongue gripping surfaces as shown from front and back below.
FRONT VIEW REAR VIEW
The denture base plates stay comfortably seated, because the tongue acts like a giant cushion, so they require very little retention. They can even be worn during sleep by some people who cannot wear dentures during the day. However, the tongue holding device cannot prevent the mouth from dropping open and releasing the tongue during sleep, so it is often combined with a chin strap.
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 current study, but clinically they work well together, because they separate the tissues that contact to obstruct the nasopharynx, as seen below. Also, combining them stabilizes the upper denture base plate between the superiorly directed pressure from the tongue and the inferiorly directed pressure from the arm of the soft palate elevator.
