Physicians who focus in sleep medicine are more than familiar with obstructive sleep apnea (OSA) and the various techniques used to treat it and, ideally, allow patients to sleep a little easier.
Of course, there are positive airway pressure machines like continuous positive airway pressure (CPAP), bilevel positive airway pressure (BiPAP), and variable positive airway pressure (VPAP); however, these treatments are not always ideal for those who aren’t capable of performing the labor-intensive monitoring of these devices and the necessary reporting. So, oral appliance therapy has become a trusted alternative treatment for OSA sufferers.
“The use of oral appliances is becoming an increasingly important option for sleep apnea patients,” said Barbara Phillips, MD, MPH, FCCP, professor of pulmonary, critical care and sleep medicine at the University of Kentucky, College of Medicine and immediate past president of the American College of Chest Physicians. Of course, physicians specializing in sleep medicine aren’t ones to blindly trust a treatment. According to Phillips, oral appliance therapy has many advantages, including:
- Restrictive, labor-intensive monitoring and reporting required for CPAP not required
- Potential to control blood pressure
- More likely to reduce cardiovascular risk than CPAP
While there are a wide range of oral devices for OSA — over 100, according to the American Sleep Apnea Association — the majority do permit more independence than positive airway pressure treatments.1 However, when individuals aren’t forced to see a clinician regularly, particularly regarding an at-home appliance, keeping up with the maintenance of those devices may be put on the back burner.
Dangers of Neglect
Becoming negligent about oral appliance maintenance can have grave effects, including deterioration of the appliance, plaque buildup or, worse yet, respiratory infection. However, these potential side effects are entirely avoidable.
SEE ALSO: Oral Appliance Therapy for OSA
“Most patients are able to keep their mandibular advancement devices for obstructive sleep apnea or primary snoring properly clean just by following simple instructions given during their visit to the dental clinic,” said Isabel Moreno-Hay, DDS, PhD, clinical director of the Orofacial Pain Center at the University of Kentucky College of Dentistry.
While physicians who specialize in sleep medicine often are the initial contacts for OSA patients, as Phillips explained, it’s common for those physicians to refer their patients to a dentist for future check-ups. “My dental colleagues are superb at management and follow-up of patients for whom they have provided oral appliances,” she said. “They are also quite good at education of patients, including about how to clean their oral appliances.”
Although the maintenance of oral appliances for OSA is ultimately left up to each individual patient, physicians should not expect patients to automatically know how to clean their devices. “Cleaning instructions should be carefully explained by the dentist or dental assistant, and any questions that the patient might have in this regard should be answered before leaving the clinic with the appliance,” Moreno-Hay advised. “Additionally, it is strongly recommended to provide these cleaning instructions, as well as other recommendations given by the manufacturer, in a written handout, which the patient can refer to at home.”
Beyond the initial visit, during which the patient should be given proper cleaning instruction, physicians should use regular follow-up visits to ensure that the directions are being followed. “Regular follow-up visits give the dentist an opportunity to inspect the device for wear and function, as well as the patient’s compliance with daily cleaning of the appliance,” said Moreno-Hay. “If the patient has failed to properly clean his or her device, the initial instructions should be reinforced. In addition, professional cleaning and disinfection of the oral appliance can be performed as needed.”
As OSA is often a chronic condition, patients can often expect to switch between treatments throughout their lifetime. When changing from one oral appliance to another, it’s critical that the patient is made aware of the cleaning process for the new appliance.
“There are many different designs and materials utilized for the fabrication of mandibular advancement devices, ranging from acrylic appliances with stainless steel hardware, to appliances that utilize acrylic with soft methyl methacrylate lining,” said Moreno-Hay. “Therefore, in order to properly maintain the device, both the manufacturer and dentist’s recommendations should be followed to increase the useful life of the appliance.”
While instructing patients to keep their oral appliances hygienic may seem relatively simple, clinicians working with OSA patients must be diligent about issuing directions.
“Oral appliance therapy has demonstrated to be an effective treatment for the management of sleep-related breathing disorders such as primary snoring and obstructive sleep apnea,” said Moreno-Hay. “The success of oral appliance therapy relies on a multidisciplinary approach and regular follow-ups with the sleep physicians and sleep medicine dentists.”
Sarah Sutherland is on staff at ADVANCE. Contact: email@example.com
1. American Sleep Apnea Association. OSA Treatment Options.