Night Guards and Sleep Apnea
Sleep apnea is a common condition in the United States. It can occur when the upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. This is known as obstructive sleep apnea. The “apnea” in sleep apnea refers to a breathing pause that lasts at least ten seconds. More than 18 million american adults have sleep apnea, but it occurs in all age groups and both sexes. Childhood sleep apnea is gaining prevalence with some estimates showing 2-3% of the US population, however, those estimates could be as high as 10-20% in habitually snoring children.
Obstructive sleep apnea occurs when the muscles in the back of the throat fail to keep the airway open, despite efforts to breathe. Another form of sleep apnea is central sleep apnea, in which the brain fails to properly control breathing during sleep. Obstructive sleep apnea is far more common than central sleep apnea.
Sleep apnea can cause fragmented sleep and low blood oxygen levels. For people with sleep apnea, the combination of disturbed sleep and oxygen starvation may lead to hypertension, heart disease and mood and memory problems.
Treatment for diagnosed sleep apnea in our office is an oral sleep appliance. These are used to open the airway by moving the lower jaw forward, thus moving the tongue away from the oropharynx. This allows improved airflow, increases the oxygen levels in the blood, and reestablishes the normal sleep pattern. The market for types of appliances has increased and can be confusing for patients, however, Dr. Morelli highly recommends the TAP III Elite sleep appliance, which he uses most often and calls it the Ferrari of oral appliance therapy.
Delivery of a sleep appliance takes two appointments. The first appointment involves full mouth impressions of your teeth, a bite registration to determine your bite relationship, fabrication of a jaw muscle deprogrammer, and fabrication of models. The second appointment is the delivery, adjustment, and instructions for use.
Dental guards are recommended treatment for patients with nocturnal or daytime teeth grinding (bruxism) habits. In addition to limiting teeth wear, night guards (NG) help to support the muscles used to chew and the jaw joint called the temporomandibular joint (TMJ). In some cases, patients with severe habits and or symptoms will need to be referred to a TMD (Temporomandibular Dysfunction) specialist, or a sleep clinic for further diagnosis and treatment.
There are two main types of night guards: soft, which is flexible and preferred by mild bruxism patients, and hard, which is not flexible and made for patients with mild to severe bruxism and misaligned teeth. Options are discussed prior to fabrication of the night guard. Both types will last from 1-5 years on average before need for replacement.
If you decide to try a dental night guard, consider the following points for best results:
- Custom-fit: fabricated from molds taken of your teeth, delivered on a separate appointment and adjusted for optimum fit and function.
- Over-the-counter: purchased at a store or pharmacy, generally adequate to relieve grinding, not intended to relieve muscles or joint pain, fit is fair to poor, and inexpensive.
- Sleep Apnea: diagnosis of SA will preclude and limit the use of a guard. A sleep appliance should be worn during night hours in lieu of a night guard.