According to information on the AADSM website “the American Academy of Dental Sleep Medicine supports new guidelines that identify oral appliance therapy as an effective treatment for obstructive sleep apnea. The guidelines, issued by the American Academy of Sleep Medicine and published in the February 2006 issue of the journal SLEEP, indicate that patients can use oral appliances as therapy for mild to moderate cases of obstructive sleep apnea or when continuous positive airway pressure (CPAP) is not a viable treatment option.”
Examination of the guidelines reveals that the AASM (American Academy of Sleep Medicine) recommends that
“Oral appliances should be fitted by qualified dental personnel
who are trained and experienced in the overall care of oral health,
the temporomandibular joint, dental occlusion and associated oral
structures. Dental management of patients with OAs should be
overseen by practitioners who have undertaken serious training in
sleep medicine and/or sleep related breathing disorders with fo-
cused emphasis on proper protocol for diagnosis, treatment,
and follow up.”
This very important statement by the AASM emphasizes the importance of expertise in treatment of TMJ disorders for dentists involved in the treatment of Sleep Apnea with oral appliances. The National Heart Lung and Blood Institute (NHLBI) considers sleep apnea to be a TMJ disorder. The report “CARDIOVASCULAR AND SLEEP-RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS” can be found at http://www.nhlbi.nih.gov/meetings/workshops/tmj_wksp.pdf Two excellent articles on TMJ disorders “SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER” and “Neuromuscular Dentistry” can be found on the Sleep and Health website.
The AASM states that
“Although not as efficacious as CPAP, oral appliances are in-
dicated for use in patients with mild to moderate OSA who prefer
OAs to CPAP, or who do not respond to CPAP, are not appropriate
candidates for CPAP, or who fail treatment attempts with CPAP or
treatment with behavioral measures such as weight loss or sleep-
This statement by the AASM that oral appliances are not as efficatious as CPAP does not take into account patient compliance. When patient compliance is factored in oral appliances are as effective as or more effective than CPAP. While CPAP is still considered the Gold Standard of treatment it is a very tenuous standard since studies have shown that the majority of patients fail to continue use on a long term basis and many refuse the therapy entirely.
The AASM recommends that “To ensure satisfactory therapeutic benefit from OAs, patients
with OSA should undergo polysomnography or an attended car-diorespiratory (Type 3) sleep study with the oral appliance in place after final adjustments of fit have been performed”. This is extremely important according to Dr Shapira who frequently has sleep labs do live titration of his patients during follow-up polysomnography to achieve better results. Dentists should have follow-up sleep studies done on all oral appliance patients. While oral appliances are not always 100% effective they are always better than no treatment. The majority of patients who abandon CPAP are currently left untreated but Dr Shapira is changing that with his website http://www.ihatecpap.com that thousands and thousands of patients visit every month to learn more about Dental Sleep Medicine as an alternative to CPAP.
An exciting new entry into the field of Dental Sleep Medicine is the TAP-PAP mask which allows dentists to improve CPAP comfort by utilizing oral appliances to maintain the masks in position eliminating many common CPAP problems associated with straps and excess pressure as well as leaky masks. Custom masks retained by an oral appliance that are “very minimalistic” can also be made by taking impressions of the facial structures and using techniques similar to denture construction.
It is vital that dentists treating sleep apnea be well trained according to the AASM that stated “Dental management of patients with OAs should be overseen by practitioners who have undertaken serious training in
sleep medicine and/or sleep related breathing disorders with focused emphasis on the proper protocol for diagnosis, treatment, and follow up.
Dr Ira L Shapira is a Chicago area dentist who supports the AASM in recognizing that expertise in treating TMJ disorders is essential, especiall considering that even the NHLBI of the NIH cosider Sleep Apnea to be a TMJ disorder that can effect not only sleep but cardiovascular function as well. Dr Shapira founded http://www.ihatecpap.com to increase public awareness of sleep disordered breathing and the important role of Dental Sleep Medicine in providing comfortable and effective treatment alternatives to CPAP. The majority of patients offered a choice of CPAP and/or oral appliances chose the comfortable oral appliances by a landslide.
Dr Shapira is a pioneer in the field and did research in the 1980’s as a visiting assitant professor at Rush Medical School on jaw relations in TMD patients and sleep apneics. He was one of 20 Charter members of the Sleep Disorder Dental Society which after 19 years has become the American Academy of Dental Sleep Medicine. He was a credentialed member of the Sleep Disorder Dental Society and is a Diplomate of the American Board of Dental Sleep Medicine. Understanding TMJ disorders and being able to treat them is an essential aspect of Dental Sleep Medicine. Dr Shapira is a Fellow of the International College of CranioMandibular Orthopedics the original organization dedicated to advancing Neuromuscular Dentistry ofr treating TMJ disorders. He is a former International Regent and is currently the Secretary of ICCMO and its representative to the Alliance of TMD Organizations.
Dr Shapira who is also a Founding Member of DOSA (The Dental Organization for Sleep Apnea) and a Diplomate of the American Academy of Pain Management teaches a comprehensive course on Dental Sleep Medicine at his Gurnee office. He limits his classes to six new dentist to insure that they understand this vital field and how to manage the jaw relations of patients with TMJ and Sleep disorders. In addition to the course he continues to mentor his students in the treatment of sleep apnea and TMD. His courses follow a similar pattern but each class is unique because of what each individual doctor bring to the course. “I am supposed to be the teaches” states Dr Shapira “but I always find I learn from my students both at my course and during follow-up telephone sessions.” Dentists who have taken his Dental Sleep Medicine course are welcome to repeat it for a minimum charge.
The websites http://www.ihatecpap.com and http:ihateheadaches.org are dedicated to two of the most important fields of dentistry: Treatment of Sleep Apnea and Snoring and Neuromuscular Dental Treatment of TM Joint disorders, Migraine treatment ant the treatment of Chronic daily and Tension-Type headache.
Dr Shapira treats patients in Gurnee at his dental practice (http://www.delanydentalcare.com) where he incorporates Dental Sleep Medicine and Neuromuscular Dentistry into his general dental practice. He also treats Sleep Apnea at Chicagoland Dental Sleep Medicine Associates (http://www.chicagoland.ihatecpap.com/) with offices in Skokie, Schaumburg, Vernon Hills, Bannockburn and Chicago. He will be incorporating treatment of TMJ disorders and Neuromuscular Dentistry next year into the Chicagland Dental Sleep Medicine practice.