Healthy Smile: I Fixed my OSA, but My Teeth Are a Mess (Part 1)

by Jeffrey Gross, DDS, FAGD of The Healthy Smile

On my schedule was a short description of this patient’s needs which mentioned apnea and Invisalign. Once again, she was new to the practice, and I didn’t know where I was headed in terms of her problem. She told me about her Obstructive Sleep Apnea, which I abbreviated in the title to OSA. Before we get to her problem let’s spend a little time learning about sleep apnea. There has been a lot of press in the past decade or so discussing this sleep disorder. Our society has created so many impediments to getting a good night’s sleep that patients seek help to solve this frustrating problem.

Before the words, “sleep apnea,” is the word “obstructive.” That word describes the cause of the apnea, which means stopping breathing. If our airway is blocked for any reason, we do not get sufficient air into our lungs. In mild cases, snoring can occur as air tries to move through the airway. In more severe cases, we stop breathing for a moment which results in waking up. Once we wake up, we get a good gulp of air, and all is good. Well, not exactly. We have air in our lungs, but now we are up in the middle of the night. In severe cases, this can happen many times resulting in poor-quality sleep.

For many years the gold standard to correct this problem is a device called a CPAP machine. CPAP stands for Continuous Positive Airway Pressure. This apparatus involves a mask that fits over the patient’s face. The mask is connected to a machine which makes sure that the air pressure helps to keep the airway or breathing path unobstructed. Many, if not most, people who treat sleep disorders go to this device first as the results are typically excellent. However, there is one large problem with a CPAP machine. Many patients find the device uncomfortable to wear and can not sleep with it. They try their best to use the machine but using it becomes an impossibility.

There is an alternative approach to managing sleep apnea that involves an oral appliance. Using something that you put into your mouth, allows the airway to stay open. The usual obstruction of the airway involves the tongue falling backward and blocking the flow of air. An oral device moves the lower jaw forward and creates an open path for the air to flow. When the CPAP approach fails, doctors will refer the patient to a dentist to make such a device.

If one does not have a dentist or decides to do their own care for whatever reason, one can purchase a plastic mouthpiece that you boil and adapt to your mouth. These devices will also hold your jaw forward as a professionally made device does and keep the airway open. As I have written on many occasions, there are consequences to all oral treatments, whether performed by a professional or self-administered. Our patient bought such a device and solved her sleeping issues, however, she moved many of her teeth so now her smile is less than ideal. She is not happy with the way she looks. She came to me for a solution to her sleeping problems and her esthetic dilemma.

Let me explain why helping her is not straightforward. To fix her cosmetic issue or tooth position, orthodontics is indicated. Orthodontics is a dental discipline that focuses on moving teeth for a specific reason. To move teeth, forces must be applied by some type of device. If she wears an orthodontic device, then how can she wear her sleep apnea appliance?

I must admit that the problem is complex and at first glance, there is no good solution. I am running short on space so I will continue this subject next week. In the meantime, if you have a cosmetic dental problem or any other type, please feel free to call me at 440.892.1810 and set up a visit and arrange for us to meet. As always, I look forward to hearing from you.

Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.

The Healthy Smile • 27239 Wolf Road, Bay Village, OH 44140 • 440-892-1810 •

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