Sleep Disorders

Dr. Della Bella specializes in the treatment of snoring and mild-to-moderate Obstructive Sleep Apnea (OSA) by utilizing various types of dental appliances. In an effort to be as conservative as possible in the treatment of our patients, the devices offer an excellent starting point in alleviating these problems. They are relatively cost-effective and have a wide range of patient acceptance compared to other treatment modalities (i.e.,surgery).

Certain steps are necessary in the construction of an appliance in order to ensure patient safety and maximal success. We do all we can to be sure our patients are satisfied – and, in this case, their spouses too!!

Step 1-Accurate, Thorough Diagnosis
First and foremost, it is critical to screen the patient for the presence and severity of sleep apnea. Because of the potential serious results of the disorder, it is important that the patient know whether he/she has the problem. Sleep apnea is a condition characterized by periodic breathing interruptions during sleep. Some symptoms include excessive daytime drowsiness, morning headaches and hypertension. Any patient whom the dentist suspects as having sleep apnea will be referred to a physician or a sleep-disorder clinic for evaluation before treatment with the Sleep Appliance. Also, preoperative patient completion of a questionnaire and informed-consent form is needed.

Our level of success is directly related to accurate diagnosis and appropriate patient selection. For example, research shows that these appliances are most likely effective if the patient is not over 125 percent of his or her idea body weight. Patients over 150 percent of their idea body weight generally will not have a favorable response.

Patients with a history of Temporomandibular Joint Dysfunction (“TMJ”) require special attention depending on the severity and type of bite that they have.

Step 2-Construction of the Appliance
Impressions of both the upper and lower dental arches are taken so models of the teeth can be made. A bite recording is made next for the purpose of relating the models in the appropriate way. Our objective in appliance construction is to hold the lower jaw forward of the upper jaw, pulling the tongue forward and enlarging the airspace between the base of the tongue and the back of the throat.

Step 3-Appliance Delivery and Patient Instructions
The appliance delivery is simple and needs only to be evaluated for retention and areas of discomfort. After one week we reappoint the patient to make any necessary adjustments and to evaluate the stress on the patient’s Temporomandibular Joint, if any.

The apneic or chronic snorer should wear the appliance every night. Others who are aware of factors that contribute to their problem (for example, tranquilizers or alcohol consumption) can wear the appliance only when needed.

Patients should expect increased salivation initially, but this decreases as they become accustomed to the appliance. Also, the posterior teeth, upon removal of the appliance, may be separated slightly. This harmless condition returns to normal in only a few minutes. It is helpful if the patients reposition their teeth and then squeeze and hold for five seconds, repeating three times each morning after taking out the dental appliance.

A Word About Insurance
If a patient has a simple snoring problem, some dental-insurance policies may pay for part of the fee. For documented OSA cases, some medical-insurance policies will cover the cost of the appliance.

In Conclusion
Dr. Della Bella has been working in the area of “Sleep Disorder Dentistry” for over 15 years. There are many medical specialists in the Greater Cincinnati area who work with us as well. If you have a snoring or mild to moderate case of Sleep Apnea, discuss the possibility of an appliance with your physician or feel free to call or email us for a complimentary evaluation.