Treatment Options and Technologies

Oral Appliances

Overview of Oral Appliance Therapy

Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices, worn in the mouth, similar to orthodontic retainers or sports mouth-guards. They are worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake and help to provide normal sleep in people who snore and have a medical condition known as sleep apnea.

Oral appliance therapy involves the selection, design, fitting, and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat.

Currently, there are more than 100 different types of oral appliances available. Oral appliances may be used alone or in combination with other means of treating OSA, including positional therapy and weight management, surgery, or Continuous Positive Air Pressure (CPAP).


Oral appliances work in several ways:

• By repositioning the lower jaw, tongue, soft palate, and uvula
• By stabilizing the lower jaw and tongue
• Dilating the muscles in the airway

Dentists with training in oral appliance therapy who are familiar with the various types and designs of appliances can determine which one is best suited for your specific dental and medical conditions. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and ongoing care. Oral appliance therapy can take from several weeks to several months to complete. Even after the initial phase of treatment is completed, Dr. Pecenka or Dr. Herald will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.

Surgery

Treatment may also include surgery to the soft palate, uvula (the tissue that hangs down from the roof of your mouth), and tongue to remove the tissue that collapses during sleep. More complex surgery can reposition the mandible (lower jaw) and facial bones, but this is done only in extreme cases.

Which Appliance Is Best For You?

Dr. Pecenka and Dr. Herald use many diagnostic tools to determine which appliance best addresses the patient's particular problem. Radiographs (X-rays) and scans help the doctors visualize the hard and soft tissues that make up the airway and form a basis for determining the proper re-positioning of the lower jaw and tongue.


The Pharyngometer allows the doctors to ascertain in real time the severity and location of the airway constriction. Re-positioning the lower jaw during the acoustic survey allows the doctors the ability to analyze how to initially position the sleep appliance.

The doctors also use pulse oximetry to pre-screen patients for Sleep Disordered Breathing, as well as to determine if the appliance is optimally titrated (adjusted).

Each sleep appliance is a unique, custom fabricated medical device that is adjusted specifically to optimize the patient's breathing at night during sleep.

Technology

Our office is equipped with state-of-the-art equipment necessary to identify, diagnose and treat snoring and sleep apnea.

• The ARES Unicorder sleep by Watermark Medical is a Medicare-approved Type II ambulatory sleep study unit. It is used to provide a sleep physician the information necessary to diagnose sleep apnea. Additionally it is used to confirm that the appliance is properly titrated.
• Portable pulse oximetry is used to measure blood oxygen levels throughout the night and changes in heart rate during sleep, which may indicated an issue with sleep disordered breathing.
• Pharyngometry, which is a 3-dimensional airway examination, is a simple, noninvasive diagnostic tool that allows the doctors to identify areas of constriction in the airway. A pharyngometer assists the doctors in determining a course of treatment.