There are over 1 billion people worldwide who are under diagnosed and under treated for sleep apnea and sleep related breathing disorders. Recently, in January of 2021, the US government commissioned AHRQ to do a retrospective study (over a 100 pages) looking at all past studies on CPAP and/or PAP therapy, including all the randomized controlled ones. Their findings were impactful; however, it was no surprise that when evaluating mean disease alleviation (MDA), Apnea burden/load and Sarah Index, CPAP fails to show any long term effectiveness. Furthermore, Phillips have recently alerted a massive recall on their CPAP machines for sleep apnea. If CPAP, viewed by some as the “gold standard” is deemed, “failure” for long term successful outcomes, then what is available in the literature to use as an alternative?
The answer is with the field of dental sleep medicine. There are several options ranging from customized oral appliance therapy with validation of therapeutic bite position to reduce RDI and oxygen desaturations during sleep, to options like orthotropics (Craniofacial Epigenetics and Pneumopedics or the Fixed Osseo Remodeling Appliances) and more surgical options such as maxillary skeletal expanders (MSE II) and Inspire, etc. Moreover, precision and technology with milling machines, Cone Beam (CBCT) and intra-oral scanners allow for manufacturing of accurate appliances and treatment options. Materials such as controlled cured PMMA and other precision based tools are now utilized in dental sleep medicine.
Recent clinical case series and feasibility studies along with White papers in the field of orthotropics have been published. These options allow for both craniofacial changes and airway collapsibility improvements all to be obtained for sleep apnea treatment. Orthodontic options in conjunction with surgical assisted treatments have also been shown to be effective. They are successful in not only reduction of apnea severity and levels of oxygen desaturation, but also help with postural and nasal breathing.
The number of co-morbidities connected to untreated sleep apnea is astounding. From Alzheimer’s/Dementia, to stroke/ myocardial infarction/ cardiovascular issues to cancer, immune system problems (can be associated with fighting infections, including COVID), diabetes and even depression, fibromyalgia, the list goes on and on. When CPAP fails with poor adherence and major compliance issues, patients will be seeking for alternatives and reliable/ well researched options. Studies in dental sleep medicine have shown to not only dramatic improve home sleep study and polysomnography results, but also allow patients to improve overall quality of life, reduce reliance on synthetic pharmaceuticals, and having root cause addressed and treated.
Dentists now have many tools, precision based medicine and clinical treatment options to help the world with untreated sleep breathing disorders.
