Obstructive Sleep Apnea Syndrome (OSAS) is a respiratory sleep disorder, which is repeated episodes of complete or partial obstruction of the upper airway with signs and symptoms that may lead to the onset of major systemic dysfunction causing a reduction in the quality of life.
In this article we remind you of the different Endoral devices that you can offer to your patients in the clinic. Many times patients are not aware of this problem, which is why the task of the dentist is essential at this stage. This problem can also have a surgical solution, but here we will only deal with the approach from the dental side. Given the relevance of the topic, the specific training on the subject of diagnosis and treatment of respiratory sleep disorders is encouraged especially during university.
Endoral devices for sleep apnea.
The oral devices (OD) or oral appliances (OA) are one of the conservative therapeutic choices for the symptomatic treatment of obstructive sleep apnoea syndrome (OSAS). They are nocturnal endoral devices that stabilise the upper airways and increase their diameters, inducing a decrease in the collapsibility of the pharynx. There are two categories of endoral devices for the treatment of respiratory disorders in sleep:
Tongue Retaining Devices.
TRDs are the first devices designed to reduce snoring and apnoea in adult patients - they are made of soft acrylic, equipped with an elastic bulb at the front where the tip of the tongue can be sucked in and retained due to the negative pressure. This "suction effect" on the tongue determines its position during sleep and favours an increase in the tension of the pharynx walls through an increase in the diameter in the lateral and antero-posterior directions.
Mandibular Advancing Devices.
MADs consist of devices of various designs that induce the advancement and distraction of the lower jaw. The control of the mandibular position is guaranteed by a dental anchorage. The first MADs were applied between the late 1980s and early 1990s and the first results on their effectiveness were reported in the New England Journal of Medicineby Peter George, who published an article on an acrylic monoblock device, with retention hooks to the dental elements.
Madibular propulsion induces:
- Increased tone of the muscles of the base of the tongue, which moves away from the posterior wall of the pharynx and causes a reduction in the tendency to verticalize;
- Increased velopharyngeal diameter, especially in its laterl position,due to the anatomical cintiguity between the madible, tongue and tonsilar pillars (palatopharyngeal muscle and palatoglossus).
To check the effectiveness of the device, it is strongly recommended that the patient reports daily, on a special card. The amount of snoring reported by the partner could affect the possible presence of tiredness on awakening and daytime sleepiness. Comparing the data with those recorded before the treatment, it may be necessary to check whether or not to further increase the mandibular advancement. Once the optimal level of mandibular advancement has been clinically established, a polysomnographic control study is planned with simultaneous application of the device in order to establish efficiency and document the results.
We hope that this quick and easy reminder has helped you to offer an adequate service to your sleep apnea patients