Oral Appliance: a specially designed and adjusted, mouthguard-like device, fits on the upper and lower teeth, worn during sleep repositions and hold the jaw and tongue slightly forward position. Oral appliance expands the airway and creating more room for air to flow, stabilize the oropharyngeal airway (behind the throat and the tongue airway space). Oral appliance has been shown to be highly effective and successful in the treatment and management of snoring and mild to moderate obstructive sleep apnea, and is known as the best alternative treatment modality to patients who are intolerant to CPAP or surgery.

The American Academy of Sleep Medicine published "Practice Parameters" in February 2006 for the treatment of obstructive sleep apnea (OSA) with oral appliances: 

• Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy.

• Oral appliances (OAs) are indicated for use in patients who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP.

• Patients with severe OSA should have an initial trial of nasal CPAP because greater effectiveness has been shown with this intervention than with the use of OAs.

• Oral appliances are indicated for patients who refuse, or are not candidates for tonsillectomy, adenoidectomy, craniofacial operations or tracheotomy.

Oral Appliance Therapy involves customized selection, fabrication, fitting, adjustments, and long term follow-up care, which involves management of potential complications such as malocclusion and TMJ disorders.  OAs look similar to mouth guards, but should be selected and fitted by a dentist trained in Dental Sleep Medicine to maintain unobstructed breathing during sleep.

Dentists who practice dental sleep medicine should be trained and experienced enough to the mechanical and physiological functions of these oral appliances, have in depth knowledge of occlusion and TMJ, and capable to handle possible sice effects.

OAT offers several advantages over other therapy choices: non-surgical, non-invasive, non-forceful air supply, natural way of breathing, easy to use and care, reversible, removable, no side-effect (very few if any), and is quite well accepted by patients.

EVALUATION:

 

Follow-up evaluations and assessment of efficacy is essential for a better result, long-term compliance, and successful oral appliance therapy.  

Home Sleep Study is a very advanced and sophiscated but simple to use at home. It provides essential data including:  respiratory disturbance index (RDI/AHI), oxygen saturation level in the blood (SaO2), number of sleep hours and arousal event, sleep architecture (Wake, REM, Non-REM sleep stages), sleep position (prone, right, left, supine), and measures the loudness of snoring by decibel. 

ECCOVISION (Pharyngometer, Rhinometer) is used for the objective assessment of the upper respiratory airway.  This equipment helps to measure the volume of airflow through the airway, illustrates structural and functional abnormalities in the airway, determines the most effective position of the jaw for maximum airflow, and guide for oral appliance construction.

ELECTRO-DIAGNOSTICS (Joint Vibration Analysis, Jaw Tracker, Electromyogram); is a high tech equipment to detect range of jaw joint movement, identify specific types of TMJ dysfunction, measures muscle tension in specific designated muscles.   

TMJ & AIRWAY IMAGING (Panogram, Cephalogram, Tomogram); is a valuable record to detect TMJ integrity, possible structural abnormalities in the pharyngeal airway, and bone deformities in the jaw, head, and neck region. 

TMJ, Head & Neck Pain Center is equipped with all these state of the art equipments.   Dr. Kim and his entire staff are highly trained, experienced, and certified to operate these equipment from manufacturers, utilizing them for screening, examination, records keeping before and after treatment, oral appliance fabrication guide, evaluation of treatment outcome and progress, and long-term follow-up assessment.