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Within the past 10 years, there has been a huge increase in the diagnosis and treatment of sleep disorders, such as obstructive sleep apnea (OSA), by the medical community. Because there are many patients who are unable to tolerate continuous positive airway pressure (CPAP) therapy (Figure 1) prescribed by medical doctors, dentistry has a tremendous new opportunity to help patients in the treatment of sleep disorders. The American Academy of Sleep Medicine (AASM) has designated dental sleep appliances as the top nonsurgical alternative for the CPAP intolerant patient. In addition, in February of 2006, the AASM designated dental sleep appliances to be a viable treatment for mild to moderate sleep apnea.1 This has opened the door for dentists who are trained to treat snoring/mild-moderate sleep apnea, and who want to help CPAP intolerant patients.
Dentists now have more advanced appliance choices for sleep breathing disorders. The purpose of this article is to introduce an example of a new concept in sleep therapy using a single-arched mandibular (or maxillary) oral appliance. In addition, it is important to note that we have better techniques for diagnostics and the fitting of these appliances, including the use of 3-dimensional (3-D) dental imaging. Using such techniques, dentists are capable of achieving high success rates consistently with their snoring and CPAP-intolerant patients.
SNORING
Snoring is caused by a restriction in the size of the airway with rapidly moving air vibrating the tissues in the oropharyngeal airway. If the tongue is restrained from closing the airway, the snoring dissipates.
Fifty-two percent of all Americans age 40 years or older snore.2 Twenty-seven percent of all couples more than 40 years old sleep apart because of snoring problems. A recent article in the Wall Street Journal stated that new housing construction was beginning to include 2 master bedrooms in new homes.3 In fact, the problem of bothersome snoring within households has become so widespread that separate sleeping quarters are frequently desired.
Without a reliable and broad-based remedy in use, snoring has become a ubiquitous American cultural phenomenon.