A new article in the Journal of Craniomaxillofacial Surgery looks at how sleep apnea is affected by utilization of different types of oral appliance. The increase in airway occurs at several levels. Unfortunately many dentists do not understand that there are many factors other than anterior positioning that can affect the success of oral appliances in treating sleep apnea. See the abstract below:
A very important factor are the tongue reflexes that are hard wired into our systems. There are specific reflexes such as the tip of the tongue reflex that stimulate tongue protrusion. This reflex is also known as the nursing reflex and is extremely imprortant for new born infants to learn to breast-feed. When the reflex is stimulated the newborn pushes its tongue against the mothers nipple and is rewarded with milk. The infant responds to this reward and develops a learned behavior but the reflex is the initiator of normal breastfeeding.
This same reflex is also known as the tongue/ tongue reflex and is associated with pleasure in kissing and release of the hormone oxytocin. This is also the same reflex that won’t let us leave a sharp edge alone with our tongue, but rather we “play” with it until the tongue is sore. Learn more @ www.thinkbetterlife.com
There are numerous other tongue reflexes that most dentists treating sleep apnea are not aware of. Many of the companies making oral appliances often ignore these reflexes as well resulting in poorer results or unnecessary additional mandibular advancement.
There is a common developmental pattern of both TMJ disorders and the development of UARS (upper airway resistance syndrome) Snoring and Sleep Apnea. The way the tongue fuctions determines the shape of the oral cavity and the airway The negative changes that cause TMJ disorders and Sleep Apnea primarily relate to nasal pharyngeal breathing and are Epigenetic in nature, or caused by the environment that the newborn and young children live in.
The DNA Appliance utilizes Epigenetic Orthodontics to reverse these negative changes and can cure Sleep Apnea and some TMJ disorders. The RNA Appliance is a special adaptation of the DNA Appliance allowing patients to both treat their sleep apnea and correct the underlying causes.
There are several case studies that show the DNA Appliance can cure sleep apnea but there is no long term prospective study published at this time.
J Craniomaxillofac Surg. 2014 May 20. pii: S1010-5182(14)00163-2. doi: 10.1016/j.jcms.2014.05.007.
DIFFERENT THERAPEUTIC MECHANISMS OF RIGID AND SEMI-RIGID MANDIBULAR REPOSITIONING DEVICES IN OBSTRUCTIVE SLEEP APNEA SYNDROME
Different therapeutic mechanisms of rigid and semi-rigid mandibular repositioning devices in obstructive sleep apnea syndrome.
Suga H1, Mishima K2, Nakano H3, Nakano A4, Matsumura M4, Mano T4, Yamasaki Y1, Ueyama Y4.
To clarify the mechanisms of rigid and semi-rigid mandibular repositioning devices (MRDs) in obstructive sleep apnea syndrome (OSAS), seven and 13 patients received rigid and semi-rigid MRDs, respectively. Each patient underwent polysomnographic and computed tomographic examinations at the initial consultation and after symptom improvement. Three-dimensional models of the upper airway (hard palate level to epiglottic base) were reconstructed by image processing software (Mimics version 14.2) to measure airway morphology. The mean age and body mass index were 58.1 years and 24.8 kg/m2, respectively, in the rigid MRD group and 57.9 years and 23.2 kg/m2, respectively, in the semi-rigid MRD group. The apnea-hypopnea index significantly improved (P < 0.05, Wilcoxon signed-rank test) from 22.0 to 8.9 and 20.5 to 11.5 events per hour of sleep in the respective groups. The cross-sectional areas measured at the epiglottic tip (from 2.0 to 2.6 cm2) and hard palate (from 2.6 to 3.3 cm2) levels also increased in the respective groups (P < 0.05). However, airway volume, cross-sectional area measured at the uvular tip level, and anteroposterior and transverse diameters of the airway were not significantly different. In conclusion, both types of MRDs improve respiratory status, but they affect different parts of the airway.
Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
Computed tomography; Computer-assisted image processing; Mandibular repositioning device; Polysomnography; Sleep apnea syndromes; Temporomandibular joint disorders