[ PLAY INSIDE THE BOX [
D
id you have a sandbox
when you were a kid? Some
nice clean sand mixed with
a little water and some
of mom’s Tupperware, all
the ingredients to build an
awesome castle.
For reasons too complex
to figure out, this got me
thinking about titrating our
dental devices. Remember the
envelope of function as taught
in freshman dental school,
and that from a full protrusive
position you lose the ability
to move forward as you open
more? You do recall that,
right?
When you think about what
you have control over with
OAT, it’s not much; the fit, the
vertical, and the protrusion.
So all your perfectly fitted
device needs now is
the correct vertical and
protrusive position. Therein
lies the challenge.
Imagine placing a dot on the
lower incisor, open a little;
move the jaw forward as
far as you can; open a few
millimeters more and then
move the jaw back all the
way. There you have it. Our
RICHARD DRAKE, DDS
• Large tongues and males
require more vertical
• Mouth breathers require
more vertical
final treatment position will
be somewhere within that
rectangle. I’ve heard it called
many things, but “Drake’s
Box” seems to have a musical
ring to it, don’t you think?” • Elastics and chin straps
are aids to control the
vertical
• Sometimes, opening
vertical is ALL you need
to do
So, until I have littered that
box with multiple points, I
do not concede that a dental
device “just isn’t working.”
Armed with this knowledge,
be sure to pass that along
every time you do a lunch and
learn for a physician. • If you start at 70% of max,
you’ve gone too far
Just yesterday I said to an MD,
“I’m pretty good at helping
the patient find the sweet
spot, but often times I need
more than a single guess.”
Only allowing the patient to
test at a single jaw position is
like having a CPAP machine
that is stuck on 7cm of H2O.
Please don’t tell the patient
that it’s not working. Instead,
explain that we simply need
to adjust her device. Don’t be
afraid to pick up a pen and
draw Drake’s Box (hoping
that with repetition it’ll catch
on!) and explain this to your
patients, to physicians, NPs
and PAs. • No cats allowed in
Drake’s Box!
In summary, the best advice I
can pass on for now: Dr. Richard Drake has been
exclusively treating snoring
and apnea for 20 years. He
Co-Founded Dental Sleep
Solutions and DS3 and has a
state of the art sleep practice
in San Antonio, TX.
• Less vertical is more
comfortable, but MOST
people require more
vertical
• Some patients do better
with less protrusion
• Slow, slow, slow titration
is the key
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RICHARD DRAKE, DDS