A thorough intake consultation, clinical exam and history review will determine the likelihood of sleep apnea. Dr. Buck may administer an "ambulatory" or take home sleep study to gather important data to further understand the scope and severity of the sleep disturbance. At this point, if a prior PSG (polysomnograph) administered by a certified sleep center and interpreted by a sleep physician has been completed, then Dr. Buck can commence fabrication of an oral sleep appliance.
Alternatively, if no PSG has been completed, Dr. Buck will require referral to a sleep center for completion of a PSG and physician interpretation before oral appliance therapy begins. It is critical to carefully and thoroughly manage this deadly disease with a team approach.
Treatment sequence Oral Sleep Appliance Therapy with prior diagnosis of OSA by Sleep MD
1- The treatment process involves records, history and clinical exam along with dental impressions of the jaws. Dr. Buck will carefully take a calibrated bite to open the airway with instrumentation to start appliance therapy. If greater than 1 year since PSG, Dr. Buck will administer take home study for baseline prior to OAT (oral appliance therapy).
2- Delivery of appliance with any adjustments for comfort and fit. Instructions for completion of adjunctive sleep logs, and specific instructions on patient guided titration.
3- One month interval checks between months 2-5 for review of sleep logs, physical evaluation and check on appliance. Possible custom calibration of appliance for increased efficiency.
4- At completion of titration phase (4-6 mos.), administration of ambulatory/take home sleep study to objectively measure appliance therapy results
5- Possible referral back to sleep physician or other medical professional for further management, or possible of co therapy to increase effective treatment results
Treatment sequence: Oral Sleep Appliance Therapy without prior diagnosis of OSA
1- Consultation and intake screening exam. Possible administration of take home/ambulatory sleep study. Results to be sent to sleep physician for interpretation
2- Referral for PSG and formal diagnosis from certified sleep center and physician (Dr. Buck will consult with sleep physician on course of therapy or therapies to best manage patient)
3- If appropriate, records, impressions, and calibrated bite for fabrication of sleep appliance.
4- Delivery of appliance with instructions
Possible course of actions after delivery of appliance
A-Referral back to sleep center for adjustment of CPAP and initiation of co-therapy
B- If Truly CPAP intolerant (presumes moderate to severe OSA) than sleep physician supported Oral Appliance Therapy with supervision to maximal improvement (MMI) in place of CPAP
C- If other nasal airway problems, referral to ENT physician for nasal patency treatment either before or during OAT treatment.
OAT Treatment Considerations
Oral appliance therapy (OSA) is very effective, safe and very well tolerated by patients. These appliances are medically tested and certified as effective in the management of mild to moderate OSA. It is critical to understand that "snoring" guards, or other over the counter devices, including snoring remedies are dangerous at best. The disease of OSA is not a social nuisance, but rather a deadly disease if not treated. By simply attempting to treat snoring, a patient may unintentionally worsen the condition, and hasten serious medical complications.
Dr. Buck also strongly believes that OAT is not intended to supersede or compete with proper management of OSA by CPAP. Some dental sleep treatments are marketed as replacing properly fitted and adjusted CPAP by qualified sleep physicians, this is not in the patient's best interest. Take home studies are a good baseline and tool for progress, should not be substituted for medically supervised PSG. Dr. Buck believes all suspect OSA should be diagnosed properly by physicians, and management should be a collaborative, team approach for the best results. Poorly-treated OSA, will still lead to very undesirable medical complications, or contribute to other deadly diseases such as diabetes, obesity, hypertension, stroke and cardiovascular disease.
OAT has few complications. These would include slight movement of teeth and opening of contacts (space between teeth); increase in untreated TMJ related pain such as headaches, jaw and tooth pain, joint pain; changes in bite making the bite not as uniform as before OAT. These are acceptable complications given the serious nature of untreated or poorly treated chronic OSA. Since Dr. Buck is a TMJ expert, he can assist in treating this condition, which commonly accompanies OSA. If TMJ problems were unrecognized before OSA treatment, OAT may unveil this and require subsequent management.