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Dental Tribune Middle East & Africa Edition

24 Dental Tribune Middle East & Africa Edition | September-October 2014ortho tribune An adult Snore-Cure appliance. (Photos: Ortho-Tain) Analyze adult snoring carefully By Earl O. Bergersen, USA S noring in an adult is con- sidered to be a most im- portant symptom that is strongly associated with day- time sleepiness, inattention, restlessness while sleeping, high blood pressure, stroke, atrial fibrillation, heart attacks and even diabetes. It is consid- ered a frequent cause of auto accidents because of daytime sleepiness and lack of attention. What should a doctor be asking to gain important diagnostic hints as to potential problems strongly related to snoring? Helpful questions can be sum- marized as follows: 1. Do you snore? 2. How often? Two to four nights a week — this is consid- ered moderate snoring. If it is five to seven nights per week, or almost always when sleeping, it is considered habitual. 3. Is the snoring interrupted by a cessation in breathing? When the breathing resumes, the pa- tient usually shifts the head to one side but may or may not wake up. 4. Count the number of seconds the breathing has stopped. If it is 10 seconds or more, and if these cessations occur at least 10 times per hour, this is con- sidered a serious problem, usu- ally involving sleep apnea. 5. Does the patient seem to have difficulty breathing while sleeping? This is a sign of hy- popnea, another serious form of sleep disturbance that is very similar to apnea (the com- plete cessation of breathing). 6. Does the patient often fall asleep watching television or while reading a book? 7. Most often (but not exclusive- ly),itisamiddle-agedmalewho is overweight and has a large neck size (usually 17 inches or more). There are, however, those who have serious sleep- disordered breathing problems who are not overweight and are not a typical candidate. How should the doctor deal with a snoring patient? To sim- ply issue an anti-snoring device will solve the irritating snoring problem but may ignore much more life-threatening symp- toms as mentioned above. The simplest way is to use a home-night study, which con- sists of a device (such as sup- plied by Res-Med) that can monitor not only the severity of snoring (intensity of sound, frequency and when it occurs), but the type and frequency of apnea, blood oxygen and num- ber of breaths, etc. If there is no evidence of apnea (a complete cessation of breathing) or hy- popnea (labored breathing), then a snoring device could be prescribed. A simple device is called a Snore-Cure, which is pre- formed and advances the mandible and tongue at differ- ent amounts (4 mm and 7 mm from an end-to-end incisal position). The 4-mm advance- ment (Snore-Cure) appliance is used for those individuals with an overjet (horizontal jaw discrepancy — posteriorly positioned mandible or anteri- orly positioned maxilla or pro- trusive incisors) that exceeds 4 mm. The 7-mm advancement appliance is for those with a fairly normal overjet (less than 4 mm) and those with severe snoring problems. The posterior section of the mandibular half of the appli- ance can be lined with a spe- cifically formulated self-cure acrylic to maintain the ap- pliance in the mouth while asleep. This is not necessary in most cases because the ap- pliance rarely ever falls out of the mouth. If the patient’s teeth are crooked, it is advisable to trim the inside of the appliance so that minimal pressure is placed on these teeth. The two adult Snore-Cure ap- pliances are available in an open and a closed version: (a) the 4 mm mandibular advanc- ing appliance for overjets of 4 mm or more and (b) the 7 mm advanced style for normal overjets and severe snorers. These adult appliance are not to be used in patients younger than 20 years of age.

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