Ashwin Lewis
Sleep dentistry, also known as sedation dentistry, involves the use of sedation to relax patients during dental procedures. It is often used for patients with dental anxiety or phobia, and the level of sedation depends on the patient's needs and the procedure being performed. While it is generally safe when administered by a licensed dentist or healthcare provider, certain people, such as those with sleep apnea, should consult their doctor before proceeding with sedation. Oral appliances or mouthpieces are also used to treat sleep apnea by gently moving the jaw forward to open the airway and improve breathing. These dental devices can be custom-made by dentists to fit an individual's mouth, but they may be uncomfortable and are not effective for everyone.
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What You'll Learn
Oral appliances for sleep apnea
Oral appliances are dental devices or mouthpieces that are worn in the mouth to treat obstructive sleep apnea (OSA). They work by keeping the airway open during sleep, preventing breathing pauses and improving sleep quality. Oral appliances are recommended for people with mild to moderate OSA, and in some cases, they can even completely resolve symptoms. They are also a good option for those with severe OSA who cannot tolerate positive airway pressure (PAP) therapy, the most effective and well-studied OSA treatment.
There are two main types of oral appliances: mandibular advancement devices (MADs) and tongue-retaining devices (TRDs). MADs are the most frequently used oral appliances and are secured to the teeth to move the lower jaw forward, repositioning the tongue and keeping the airway open. They are made of moulded hard plastic and feature metal hinges and screws that can be adjusted to push the lower jaw forward. MADs can be custom-made by dentists certified by the American Academy of Sleep Medicine or bought over the counter as "boil and bite" devices that are fitted by heating and moulding to the teeth.
TRDs, on the other hand, consist of a soft plastic splint placed around the tongue to hold it forward and out of the mouth during sleep. While TRDs can be uncomfortable and cause dry mouth, they are often covered by insurance when used for OSA treatment. It is important to note that oral appliances may not work for everyone, and side effects such as increased salivation, jaw pain, and gum irritation can occur during the adjustment period.
Another newly approved oral appliance is the tongue muscle stimulation device, which is used to treat snoring and mild sleep apnea. This device sends small electric signals to strengthen the tongue muscle tone, helping to keep the airway open over time. While initial research is promising, further studies are needed to understand its effectiveness compared to other oral appliances.
Oral appliance therapy is a non-invasive and effective treatment option for OSA, improving sleep quality, energy levels, and overall health. It is important to consult with a qualified dentist or healthcare provider to determine the best treatment option for OSA, as individual responses may vary depending on the shape of the mouth and the severity of OSA.
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Mandibular advancement devices
Made of moulded hard plastic, MADs snap over the lower and upper teeth and feature metal hinges and screws that can be tightened to push the lower jaw forward. While some dentists offer custom-made MADs, it is important to ensure they are experienced in sleep-related breathing disorders and certified by a reputable organisation, such as the American Academy of Sleep Medicine. The cost of a custom MAD can be significant, often totalling $4,000 or more, and may not be covered by dental or medical insurance for snoring issues.
MADs can be effective in improving symptoms of OSA, including daytime sleepiness and concentration issues, and reducing snoring. They are easy to use while travelling and can help users achieve deeper sleep with fewer disruptions. However, it is important to note that oral appliances like MADs are generally not recommended for severe cases of sleep apnea. Additionally, it may take time to adjust to using a MAD, and side effects such as increased salivation, jaw or tooth pain, and gum irritation may occur during the initial weeks of use.
While MADs can provide benefits, they may not work for everyone. The effectiveness of MADs depends on the shape of the user's mouth and the severity of their OSA. Some people with mild to moderate OSA find that MADs completely resolve their symptoms, while others may not notice significant improvements and may need to explore alternative treatments. It is always advisable to consult a healthcare provider or dentist before purchasing a MAD to ensure it is suitable for your specific needs.
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Oral appliance therapy
Oral appliances are dental devices or mouthpieces that are worn over the teeth during sleep. They support the jaw in a forward position, helping to keep the airway open. These appliances are typically made of moulded hard plastic and feature metal hinges and screws that can be adjusted to push the lower jaw forward, opening the airway.
OAT is an effective and non-invasive treatment that can improve sleep quality, increase energy levels, and enhance alertness throughout the day. It is a good option for people who have mild to moderate OSA or those who cannot tolerate continuous positive airway pressure (CPAP) therapy, which is considered the "gold standard" treatment for OSA. CPAP involves using a small machine that blows air through a mask to keep the airway open. However, some people find CPAP challenging to use consistently due to discomfort or other factors.
While OAT can be effective, it may not work for everyone with OSA. Some people may experience side effects such as increased salivation, jaw or tooth pain, gum irritation, and changes in their bite or jaw muscles. It is important to consult a qualified dentist or sleep specialist to determine the most suitable treatment option, as oral appliances differ from over-the-counter anti-snoring devices, which may not be as effective for OSA.
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Sedation dentistry
There are different types of sedation used in dentistry, including minimal, moderate, deep sedation, and general anesthesia. Minimal sedation refers to a patient who has reduced anxiety but can still respond to verbal or physical stimulation. Moderate sedation makes the patient even more relaxed, and they will respond to purposeful stimulation. Deep sedation and general anesthesia cause the patient to lose consciousness and become unresponsive to stimulation. General anesthesia is typically only administered in a hospital setting and is not commonly used for dental treatment.
The most common types of sedation dentistry include nitrous oxide, oral conscious sedation, and intravenous (IV) sedation. Nitrous oxide, also known as "laughing gas," is inhaled through a mask or nosepiece, and its calming effects are felt within three to five minutes. Oral conscious sedation involves taking sedative medication, usually in pill form, about an hour before the procedure. Common medications used include triazolam (Halcion), zaleplon, lorazepam, and zolpidem (Ambien). Oral sedation can range from minimal to moderate, with higher doses leading to moderate sedation. IV sedation is the deepest form of conscious sedation available in a dental setting, where sedative medications are delivered directly into the bloodstream through an IV line.
The type of sedation used depends on various factors, including the patient's medical history, level of anxiety, the length of the procedure, and personal preferences. Sedation dentistry allows patients to undergo dental procedures comfortably and safely, making it easier for both the patient and the dentist.
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Sleep dentistry under general anaesthesia
Sleep dentistry, or sedation dentistry, is a safe and effective way to help patients get through painful or unpleasant dental procedures. It is often used for patients with dental anxiety or phobias, or those who are undergoing lengthy treatments.
General anaesthesia (GA) is a type of sedation dentistry where the patient is put to sleep and rendered totally unconscious during the procedure. It is different from conscious sedation, where the patient can communicate and their protective reflexes are intact. GA is rarely used for dental treatment nowadays, as conscious sedation with drugs like midazolam is considered extremely safe and effective for most patients. The Department of Health in England (and similarly in Scotland, Wales, and Northern Ireland) recommends that GA for dental treatment in adults should only be used as a last resort.
GA is typically induced by propofol IV in the hand or arm. For children, anaesthetists may use sevoflurane gas, which is quick and does not smell as bad as older gases like Halothane. Sevoflurane is also used to maintain general anaesthesia after induction. Before the procedure, the patient is asked to breathe oxygen through a mask, and at the end of the procedure, they breathe pure oxygen to evacuate the remaining anaesthetic gas from their body.
While GA is rarely used for dental treatment, it may be necessary for patients with severe dental anxiety or phobias, adults with special needs, or young children. It may also be required for certain emergency dental situations or oral surgeries, such as particularly difficult-to-remove wisdom teeth.
Oral appliances, or dental devices, are another form of sleep dentistry used to treat obstructive sleep apnea (OSA). These devices are worn in the mouth during sleep to keep the airway open and improve symptoms such as daytime sleepiness and concentration issues. While they can be effective for some people with mild to moderate OSA, they may be uncomfortable and are not recommended as a first-line treatment.
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Frequently asked questions
Dental appliances for sleep are dental devices or mouthpieces that are worn in the mouth to keep the airway open during sleep. They are used to treat obstructive sleep apnea (OSA) and are made of moulded hard plastic that fits over the upper and lower teeth.
If you suffer from OSA, you may experience symptoms such as daytime sleepiness, concentration issues, and snoring. If left untreated, OSA can lead to other health problems. It is important to consult a healthcare professional to determine if a dental appliance is the right treatment option for you.
While Continuous Positive Airway Pressure (CPAP) therapy is considered the most effective treatment for OSA, dental appliances can be an alternative for those who find CPAP challenging to use. Dental appliances work by gently moving the jaw forward to open the airway, improving airflow and reducing snoring. However, they may not work for everyone, and some people may find them uncomfortable.
