Here is a letter from a reader James, lamenting to Dr John Russo with regards to how his spouse and those around him are affected by his snoring. He writes to Dr Russo, seeking advice on the use of dental mouthpieces as a way to manage sleep apnea.

Dr Russo explains in detail how a dental device for sleep apnea is typically used to effectively contain mild to moderate sleep apnea. He also talks about surgery as an option for those who have more severe sleep apnea. Although the success rate of surgery is relatively high at 75%, I wonder how many people are comfortable with the idea of going under the doctor’s scalpel…the thought of it alone will put off many. I am sure most people would prefer using a dental device for sleep apnea instead of going for surgery, unless of course all these devices proved ineffective.

Dear Dr. John,

My wife and even my dog have had it with my snoring, I even wake myself up, what can I do. Do those dental mouthpieces work?

James it sounds like you are a candidate for an evaluation by an ear, nose and throat doctor [ENT] or sleep disorder clinic. They can evaluate the type of snoring you have. Let me first explain what causes snoring. When you breathe, air causes the tissues of the soft palate, throat, uvula, tonsils or adenoids to vibrate creating the fluttering noises of snoring. The vibrations occur because excessive fatty tissues and overly relaxed muscles obstruct the airway. The most common tissues involved are the soft palate and the uvula. When the muscles in the soft palate relax, an upward fold occurs causing the uvula to vibrate with each breath of air. Sometimes the fold is so severe that it seals the back of the throat preventing the passage of any air to the lungs. This is called, obstructed sleep apnea [OSA]. Sleep apnea can be a terribly disabling condition. Sleep apnea can be responsible for myriad of health problem. Sleep apnea is a common disorder in which breathing stops during sleep for 10 seconds or more, sometimes more than 300 times a night. Sleep apnea is common, and affects more than twelve million Americans, according to the National Institutes of Health. Risk factors may include but not be limited to being male, overweight, and over the age of forty, but sleep apnea can strike anyone at any age. It has been documented that this condition is causative agent responsible for, headaches, high blood pressure, cardiovascular disease, weight gain, poor job performance, chronic fatigue, memory problems, mood swings and a substantial increase in the risk of being involved in a motor vehicle accident

Mouthpiece devices have been somewhat effective for many snorers, including those suffering from mild or moderate obstructive sleep apnea. Generally they are plastic devices worn in the mouth during sleep to prevent the soft throat tissues from collapsing and obstructing the airway. Their aim is accomplish this by bringing your lower jaw forward and/or by lifting your soft palate. Some devices also stop the tongue from falling back over your windpipe. Most dentists should be able to fit you with such an appliance. I would suggest you try this less costly and invasive appliance before more invasive procedures.

There are surgical procedures available to remove the uvula and stiffen the soft palate. The purpose of these surgeries is to remove the excess tissues that vibrate when you inhale. The success rates of these surgical procedures seem to fall in the forty to fifty percent range and are reported to be very painful. There is a new procedure that looks very promising. It is called the Pillar Procedure. It’s relatively simple to perform, can be done with local anesthesia and in one short office visit. The doctor carefully inserts three plastic implants into your soft plate. These implants are 18mm long by 2mm in diameter and are made of medical grade polyethylene plastic. After the implants are placed, fibrous tissue grows between the implants stiffening the tissue of the soft palate. The actual procedure only takes about fifteen minutes and costs in the range of $1200-$1600. Although the clinical trials look promising with a seventy-five percent success rate, it is a relatively new procedure.

Better smiles for all
Dr. John Russo

Dr. John J. Russo is a graduate of the University of The Pacific School Of Dentistry. A graduate of the Pacific Aesthetic Continuum. He is the director of The Cosmetic dental Center and Russo Dental Care, and author of the weekly column "As the dental doc."

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