North Texas Dentistry Convention Issue 2014 | Page 19

Just Breathe

by Jennifer Eure Fuentes

After a rollercoaster year of hearings and proposed rulings, Texas A&M
University Baylor College of Dentistry alumni with sleep-based dental

E

verything changed for Jean Graber in
1952. She was just a first grader, and
life was about climbing black walnut
trees in her backyard, playing in barn haylofts
and hanging from the monkey bars on the
school playground.
Then polio hit.

For the next three months, home became the
hospital, and those first six weeks all of her
breathing was done for her in an iron lung —
a metal tank that went up to her neck. Air
pressure changes guided her chest wall up
and down, creating the inhalation and exhalation needed to keep her alive. Graber’s
mother kept vigil while her father made the
three-hour drive back and forth to the hospital in Hutchinson, Kansas, each weekend.
A survivor of bulbospinal polio, Graber lost
complete use of her left arm and partial use
of her right. But she learned to drive using
just her legs, went to college and became
a teacher.

practices may finally get the resolution they desire. Some worry the fight
to help their patients breathe is far from over.
band make the seven-hour drive from their
farm near Pretty Prairie, Kansas, to have
Thornton make her a new custom sleep
mask.

At such visits Thornton and Graber meet at
UT Southwestern Medical Center at Dallas,
where Graber climbs into an iron lung. Since
she can’t breathe on her own when lying
down, the device is necessary while Thornton
makes a mold of the area extending from
Graber’s chin and cheeks to above her nose.

She stays in the metroplex several days while
the clear acrylic mask is created. Thornton
attaches the mask to a monoblock appliance
that uses the teeth to hold the mask in a fixed
position. The mask is then attached to a volume ventilator. A sleep study is performed to
make sure the mask doesn’t leak.

“I can just slip it in my mouth, and I’m ready
to go,” says Graber of the strapless mask. “I

love that freedom. The mask gives me independence, and that’s primary for me.”

Thornton’s ability to help — and that of many
dentists who treat patients with sleep-disordered breathing — may hinge on the outcome
of a Texas State Board of Dental Examiners
open session that took place on November 8
in Austin.

In April 2012, an Austin-based sleep dentist
began a correspondence with the state board.
He wanted clarification on what a dentist can
and can’t do in terms of treating sleep-related
breathing disorders. Currently, dentists are
permitted to independently diagnose and
treat nighttime breathing problems such as
snoring and upper airway resistance syndrome, but treatment and fabrication of oral
appliances for obstructive sleep apnea —
when the airway repeatedly collapses during
sleep — can only be done in collaboration
with a physician’s diagnosis and orders.

Graber wasn’t expecting what happened next.
In 1980 came the second diagnosis. She had
post-polio syndrome, and by 1983 she needed
nighttime ventilation.

“A lot of people who had bulbospinal polio —
which damages nerve centers that control
swallowing and talking — died before they
could figure that out,” says Graber, whose
journey to breathe during sleep began with an
airtight nylon “poncho wrap” with a sweeper
motor and has evolved to breathing masks
connected to vent