In the January 2006 issue of the medical journal Sleep, the American Academy of Sleep Medicine recommended that oral appliances be the first treatment option for patients with mild to moderate sleep apnea. This has created an excellent opportunity for dentists who want to offer oral appliance therapy to their patients to significantly improve the health of these patients.

It has been estimated that 90 million people in North America have sleep disorders and as many as 18 million suffer from obstructive sleep apnea. This is a serious health problem which increases the risk of high blood pressure, heart attacks and strokes. Dentists, as health care professionals who see their patients on a regular basis, are in an ideal position to screen their patients for sleep disorders.

The Epworth Sleepiness Scale should be utilized on a routine basis to determine if a sleep disorder exists. Fifty percent of men over age 50 snore and a large percentage of women snore after menopause. Snoring has a negative effect on relationships and marriages. Consequently, many women are interested in helping their husbands overcome this serious problem. I tell my patients that an oral appliance to prevent snoring and sleep apnea is cheaper than a divorce and better for your health.

New technology has now made it possible for dentists to evaluate the nasal airway using a Rhinometer and the pharyngeal airway using a Pharyngometer. These new diagnostic devices improve the ability of the dentist, prior to treatment, to determine whether or not oral appliances will be effective. Patients are reluctant to spend $2,500 for oral appliances unless there is some degree of certainty that they will be effective.

The diagnosis of sleep apnea should be made using a sleep study at a sleep lab called a polysomnogram. Some patients do not get a proper sleep at the sleep lab due to the fact that it is difficult to sleep in a different bed hooked up to 16 leads. The use of ambulatory sleep studies is becoming increasingly popular since these studies are considered more accurate when the patient is sleeping in their own bed. The treatment of choice would be to do a sleep study prior to treatment to make a correct diagnosis of sleep apnea and then another sleep study at the end of treatment with the oral appliance to prove that the oral appliance successfully eliminated the sleep disorder.

As many of you know, Reggie White, a pro-Bowl lineman with the Green Bay Packers, died recently of a heart attack at 43 years of age. He was diagnosed with obstructive sleep apnea and instructed to wear the CPAP, an air compressor that blows air up the nose. CPAP is considered by many in the medical profession to be the gold standard. It is 100% effective when worn at night. However, the problem is that 50% of patients who use it during the sleep study in the hospital do not return for a fitting and 80% who do wear it are non-compliant within one year. Conversely, oral appliances are extremely well tolerated by the patients and compliance is not an issue as 90% of patients are still wearing their oral appliances after one year.

Reggie White was unable to wear the CPAP but was not given the option of wearing an oral appliance. My contention is that there are thousands of patients suffering from sleep apnea that cannot wear a CPAP but would benefit from an oral appliance.