Dental Device
Delivery Simplified!
By Stephen Tracey, D.D.S., M.S.
“According to the American Sleep Apnea Association,
22 million Americans suffer from sleep apnea with
the vast majority remaining undiagnosed.”
Appliance Selection
Along with the increasing numbers of
patients seeking OAT, there has been a
surge in the number and variety of oral
sleep appliances available to practitioners.
As a result, the field of dental sleep medicine is growing at a
rapid pace. For patients that obtain a proper diagnosis,
there are two primary modes of non-surgical treatment –
positive airway pressure (PAP) and oral appliance therapy
(OAT). With most patients finding PAP therapy
uncomfortable, inconvenient and difficult to comply with,
OAT is increasing in popularity. The consulting and
market research firm, Frost & Sullivan, forecasts that
custom oral appliance revenues will increase 500% by
2020. With over 140 FDA approved oral sleep appliances
currently available, dentists are often frustrated and
confused when it comes to determining which
appliances are most effective in treating obstructive
sleep apnea (OSA), which appliances are most
comfortable for their patients, and which appliances
are the easiest to deliver, adjust and manage. As both a
practitioner of dental sleep medicine and beneficiary of oral
appliance therapy for many years, I have personally used
nearly a dozen different appliances over the past decade.
During that time I have determined seven key criteria
that I believe to be absolutely essential in an oral sleep
appliance.
1. FDA-cleared for treatment of OSA.
2. Durable, high quality construction that will provide
the patient many years of nightly use. I personally
prefer to avoid vacuum-formed appliances and plastic
inter-arch straps that tend to deteriorate both physically
and esthetically quite rapidly.
3. Comfortable for the patient to wear nightly. This
means as little acrylic and as few moving parts as possible.
4. Constructed of two separate parts (maxillary and mandibular) that allow for opening, sipping of water, and
casual conversation with a bed partner. In my experience, appliances that are fabricated as a single unit, or
even two separate parts that are locked together in the
anterior are not tolerated as well by patients, and in
some cases even create a sense of claustrophobia.
5. Maximize tongue space in the palate and between
the anterior teeth. While most practitioners understand the importance of mandibular advancement in the
treatment of OSA, creation of increased tongue space is
often overlooked.
6. Adjustable in small increments. I have often found an
adjustment of as little as 0.25 mm is all it takes to achieve
a successful outcome while minimizing the possibility of
long-term bite changes.
7. Ease of fit and adjustment to the patient’s dentition.
With this in mind, the oral sleep appliance I feel best
satisfies these criteria at this time is the DynaFlex Dorsal®
Accu-Fit® Appliance (figure 1).
FIGURE 1