In September 1995, the American Sleep Disorder Association (ASDA) endorsed oral appliance therapy as the third currently acceptable treatment modality for snoring and sleep apnea.  Snoring is a social problem particularly for the spouse, but obstructive sleep apnea poses a significant health risk for the patient in that it can lead to irregular heartbeat, high blood pressure, heart attacks and strokes.  There are literally millions of patients who suffer from these sleep disorders, and the dental profession must help them.  Dentists who are trained with a functional orthopedic background are most qualified to treat these patients because of their experience in dealing with oral appliances, particularly maxillary (upper jaw) and mandibular (lower jaw) advancement appliances, airway problems, mouth breathing, TMJ dysfunction and posterior open bites.

Sleep Apnea

Sleep Apnea is a type of breathing disorder which is serious and potentially life-threatening condition characterized by brief interruptions of breathing during sleep.  There are three types of apnea:

1. CENTRAL APNEA
   
   The upper airway is open, but not oxygen is getting to the system.  This occurs because the patient is not getting a chemical response from the brain to stimulate the lungs and the diaphragm to assist with breathing.
   
2. OBSTRUCTIVE SLEEP APNEA (OSA)
   
   The lungs and the diaphragm are functioning normally, but no oxygen is entering the system because there is an obstruction in the upper airway.
   
3. MIXED APNEA
   
   This is a combination of central and obstructive sleep apnea.

The signs and symptoms of OSA include snoring, excessive daytime sleepiness, gasping and choking during the night, non refreshed sleep, fragmented sleep, clouded memory, irritability, personality changes and morning headaches.

Children can also snore and suffer from growth and development problems including narrow maxillas (upper jaw), high palatal (roof of the mouth) vaults and retruded (pushed back) mandibles (lower jaws).  Often, they are highly allergic and their airway is blocked due to enlarged tonsils, adenoids or swollen nasal mucosa (lining of the nasal passages).  Clinical signs would indicate a:

1. Turned up nose
2. Allergic shiners under the eyes
3. Mucous draining out of the nose
4. Mouth breathing
5. Nasal sound to the voice

The retrognathic (deficient length) maxilla and mandible leads to a forward head posture which can cause postural as well as cervical problems.  Other signs are:

1. Bed wetting
2. Irritability
3. Difficulty in concentrating in school
4. Hyperactivity

Clearly, these children must be treated early in order to dramatically improve their quality of life.

If the airway problem and skeletal problems are addressed early, then the more serious problem of obstructive sleep apnea may be eliminated.  The treatment of airway problems is done with upper and lower arch development appliances along with an Ear, Nose and Throat (ENT) specialist who can remove the enlarged tonsils and adenoids.  The skeletal jaw problems can be treated with the ADVANCED LIGHTWIRE FUNCTIONAL (ALF) APPLIANCES.

The ALF appliances are used on adults as well.