Snoring and Sleep Apnea awareness is increasing at an accelerated pace. Often due to information acquired through the media, friends or acquaintances. It is important to remember that these disorders are Medical in nature. The Dentist can play a major role in both the screening and treatment process; however, diagnosis and treatment require a Physician’s expertise and prescription.
Should a Dental office screening result in a patient requiring further evaluation they should be referred to a Sleep Specialist for this evaluation and diagnosis. Due to OHIP requirements Sleep Specialists can only receive referrals through another Physician. However, a Dentist can initiate this process by referring the patient to their Family Physician along with their screening findings suggesting a referral to the Sleep Specialist.
Once evaluation and diagnosis have occurred, treatment recommendations are shared with the patient and referring Physician. First line recommendations always address appropriate Lifestyle Changes that may impact favorably on the patient’s condition. These Lifestyle Changes pertain to Weight Loss, Exercise, Smoking, Alcohol and Medication.
In mild cases, changes in these areas may be sufficient to deal with the patient’s issues. It is important for the patient to obtain a thorough understanding of all the mainstream treatment options. Consultations with the various caregivers may be necessary before deciding on their final treatment. These treatment options usually include Nasal Continuous Positive Airway Pressure (nCPAP); where a constant airflow is used to pneumatically splint the airway open during sleep. Surgery; performed by an ENT that removes soft tissue responsible for airway collapse. Or an Airway Orthotic, that advances the lower jaw, causing airway splinting and firming up of tissues.
Should a patient elect an Airway Orthotic, it is important to consider the baseline Sleep Study results in the rendering of this treatment. Often airway issues are worse while the patient sleeps on their back; referred to as Positional Dependent Apnea. In mild cases some patients may be able to manage their airway completely by simply training themselves to not sleep on their back. Knowledge of this Positional Dependent Apnea can be helpful when providing Airway Orthotic Therapy; for those cases where an Airway Orthotic provides only partial resolution, 
applying “Positional Therapy” to the patient’s treatment regimen may result in a complete success. This is of particular importance when dealing with a patient that is not a surgical candidate and that has already failed using nCPAP. Such patients are often left untreated if we cannot adequately manage them with an Airway Orthotic. Considering the patient’s Positional Dependent Apnea may make the difference between success and failure with an Airway Orthotic.
Airway Orthotic Therapy outcomes are also optimized by educating the patient regarding how certain lifestyle choices may be impacting negatively on their airway problem.
However, changes in Lifestyle such as weight loss, implementing regular exercise, reducing or eliminating alcohol consumption and smoking can sometimes take many months. Consequently, optimum Airway Orthotic outcome is sometimes not achieved for up to a year from prescription. However, without the initial partial relief an Airway Orthotic can provide these patients it is often impossible for them to find the energy or willpower to implement the permanent lifestyle changes required to be successful.
Optimizing treatment with an Airway Orthotic requires open communication with the Physician, an understanding of the Sleep Study findings and how lifestyle choices may be contributing to the patient’s airway problem. Hand–in-hand with the Physician, a knowledgeable Dentist can play an active role in both the initial screening and treatment of patients with upper airway disorders.
Considered by the American Academy of Sleep Medicine to be First Line Therapy for Snoring, Mild and Moderate Sleep Apnea, Airway Orthotics have established themselves as a very effective, patient friendly and patient preferred therapy in the management of Snoring and Sleep Apnea.
John Viviano B.Sc. DDS Diplomate ABDSM; obtained his credentials from U of T in 1983, he provides conservative therapy for snoring and sleep apnea in his Clinic Limited to the Management of Breathing Related Sleep Disorders. A member of various sleep organizations, he is a Credentialed Diplomate of the American Board of Dental Sleep Medicine, and has lectured internationally regarding management of Sleep-Disordered Breathing and the use of Acoustic Reflection. Dr Viviano has also conducted original research, authored articles and established protocols on the use of Acoustic Reflection for assessing the Upper Airway and its Normalization.
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