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Members of the SingHealth Group
Changi General Hospital KK Women s and Childrens Hospital Singapore General Hospital
National Cancer Centre National Dental Centre Centre Natioanal Heart Centre Singapore National Eye Centre
SingHealth Polyclinics
Mimi Yow BDS, FDS, MSc, FAMS
Senior Consultant, Dept of Orthodontics, National Dental Centre
Visiting Consultant, Singapore General Hospital
Clinical Assoc Professor, Faculty of Dentistry, National University of Singapore
Dental Sleep Breathing Strategies
Dr Mimi Yow, Senior Consultant, Department of Orthodontics
Members of the SingHealth Group
Changi General Hospital KK Women s and Childrens Hospital Singapore General Hospital
National Cancer Centre National Dental Centre Centre Natioanal Heart Centre Singapore National Eye Centre
SingHealth Polyclinics
Mimi Yow BDS, FDS, MSc, FAMS
Senior Consultant, Dept of Orthodontics, National Dental Centre
Visiting Consultant, Singapore General Hospital
Clinical Assoc Professor, Faculty of Dentistry, National University of Singapore
Dental Sleep Breathing Strategies
Dr Mimi Yow, Senior Consultant, Department of Orthodontics
CHILD AHI ! 1
AHI ! 5 AHI > 15 AHI ! 30
Non-sleepy snorer ! Sleepy snorer ! Sleep hypopnea ! Mild OSA ! Moderate OSA ! Severe OSA
OSA CONTINUUM
American Academy of Sleep Medicine Task Force, 1999
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OSA Culprits Child Adult
Peak age 2-6 y 30-60 y
: 1:1 1:2
AHI ! 1 ! 5
Incidence
Gen population 1-3% 2-4%
Habitual snorers 9% 10-40%
Morbidly obese 37-55% > 50%
BMI Fail to thrive ! 28 Asian
! 98th % ! 30
Caucasian
Common causes Enlarged
Adenoids Obesity
Tonsils
Causes of OSA
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OSA Facies
Retrognathic mandible
(p<0.05)
Steep mandibular plane
(p<0.01)
Increased gonial angle
(p<0.001)
Increased anterior lower face height
(p<0.001)
Kawashima, 2000
Braces in Airway Management
Pierre Robin (1902) designed the Monobloc apparatus ..
for children with adenoidism to breathe through the nose
Braces in Airway Management
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Braces in Airway Management
How do they work?
How do they work?
Tongue and lower jaw move forward
Airway widens in AP dimension
Muscle activity increases
Palatoglossus
Palatopharyngeus
Levator veli palatini
Tensor veli palatini
Genioglossus
Airway collapsibility reduced
Battagel et al., 1999
Gale et al., 2000
Ryan et al., 1999
Schmidt et al., 1991
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What is the evidence?
Evidence
*Ferguson KA et al, 2006
** Lim et al, 2009
Do they work?
Evidence
Success in 52% AHI <10
More effective than UPPP
Less effective than CPAP
BP <
SaO2 > 1-11%
< daytime sleepiness
Less effective in higher BMI
More effective in positional apnea
Better acceptance by patients
Not Recommended
Severe OSA (AHI>30)
Multiple levels of obstruction
Cannot protrude lower jaw
No teeth
Oral sepsis
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Short term side effects
Sore teeth, painful TMJ & stiff muscles
Dry mouth or drooling
Temporary bite changes
Long term side effects
Tooth decay
Gum disease
Tooth movement
Permanent bite changes
Mild facial changes
DAlmeida et al, 2006
Dental splints
Evidence
No electricity needed
Small & portable
Less visible
Less cumbersome
Better quality of life
Recommendations
American Academy of Sleep Report, 2005
OA for mild to moderate OSA
Follow-up PSG for effectiveness
Life-long follow-up for:
OSA signs & symptoms
Patient compliance
Appliance fit
Teeth, gums, jaw joints
Occlusion