Prior to administering oral appliance therapy, the providing sleep medicine dentist should complete a thorough evaluation of the patient’s periodontal health, including the use of current radiograph to assess dental disease. The initial examination should also include a review of the patient’s history of OSA symptoms and previous treatments.
A complete dental examination to assess appropriateness of oral appliance therapy should include the identification of decayed, missing and restored teeth, occlusal classification and open interdental contacts, maximum interincisal opening and overbite, overjet and mobility status. The range of normal jaw protrusion should be noted, along with occlusal wear patterns including evidence of bruxism and clenching.
TMJ issues such as muscle or joint pain or joint noise should also be considered.
An evaluation of soft tissues in the throat and mouth should include tongue size, topography and lingual extension, neck circumference and the notation of any abnormalities. Bony structures should be examined for shape, width and the depth of the hard plate, and any abnormalities in jaw size or function.
Patients considered for an appliance that holds the mandible forward in relationship to the maxilla (mandibular repositioner) should meet certain criteria to minimize negative side-effects. They must have 6 or more healthy teeth in each arch; at least one posterior tooth per quadrant; and dentition should be stable.
Major dental care should be completed prior to orthotic fabrication, and TMJ issues should be evaluated prior to treatment. If the patient’s dental health does not meet the requirements for a mandibular repositioner, then a tongue retaining device may be the orthotic of choice.
The decision as to which FDA accepted oral orthotic to be used is made based on the patient’s medical history. Patients with a history of bruxism or clenching may require specific devices that can withstand the forces created by these parafunctions.