Dental and Skeletal Management of Obstructive Sleep Apnea – The Air Station Malaysia
Dental and skeletal management of obstructive sleep apnea, or OSA, involves the use of oral appliances, surgical interventions, and other treatment options to reduce or eliminate symptoms associated with OSA. This is an integral component of patient management that seeks to avoid health complications like apnea-related hypotension (ARH), heart disease, stroke, or sudden death.
When treating patients with OSA, the initial step is to assess its severity through polysomnography (PSG) and an apnea-hypopnea index (AHI). AHI is measured using a device that records brain waves, oxygen saturations, respiratory effort, heart rate, eye movements and snoring; if an AHI of 30 events per hour occurs then patients are considered to have moderate to severe OSA.
Regarding oral appliances and splints, mandibular advancement devices (MASs) are among the most widely used oral device therapies to treat OSA. According to research from the American Academy of Dental Sleep Medicine, oral appliances may be effective at reducing AHI and improving patient quality of life while being less invasive than other treatments such as uvulopalatopharyngoplasty (UPPP) or tracheotomy.
However, studies comparing the long-term effectiveness of MAS with other therapies are scarce and may not be reliable. Thus, it is essential to evaluate both short and long-term effects of MAS on teeth, jaws, and soft tissues in order to identify a patient’s optimal treatment strategy.
MADs have been known to cause occlusal effects, particularly in older individuals with low protrusion of the mandible. This may be due to MAD’s reciprocal pressure on masticatory muscles which tends to bring the jaw back into its original position and release tension on teeth.
Malocclusion devices (MADs) have not been extensively studied in terms of their effect on bone, but one study did identify one effect: during MAD therapy the anterior ramus height decreased an average of 0.7mm while the posterior ramus height declined by 0.4mm. Patients with high masticatory forces as well as those who had significant pre-treatment obstructive snoring or sleepiness experienced more pronounced decreases in height.
MAD therapy may produce other osseous side effects such as increased lingual thickness, which increases tongue size and causes it to protrude outward. Furthermore, patients have reported decreased maxillary width and height following MAD therapy – leading to teeth that protrude beyond their usual length and creating a narrow oropharyngeal airway. Furthermore, some individuals report an upper arch length decrease after MAD treatment.
MADs typically produce temporary occlusal effects, as they can be adjusted over time to achieve ideal alignment of both teeth and jaws. However, factors such as age, ethnicity, and therapeutic pressure may have an impact on a patient’s long-term dental and skeletal outcomes.
Contact The Air Station Malaysia for more information about CPAP machines, CPAP devices, obstructive sleep apnea treatment and sleep study test.