Study on Patient Compliance in Use of Oral Appliances for SDB

John R. White, DDS, White and Siachos, PA;  Greenville, South Carolina

Diplomate, American Academy of Dental Sleep Medicine

 

INTRODUCTION: Initiating treatment for patients with SDB can be very intimidating for dental practitioners. Our dental training does not prepare us to understand the sleep-induced changes in the physiology of various organ systems or provide a working knowledge of SDB symptoms. My survey demonstrates how a general dentist, who is not an academic, well – known, or on the lecture circuit, can be very successful in treating patients with SDB.
METHODS: When SDB patients were referred to me, their initial visit consisted of a thorough review of their medical and dental history and their Sleep Study, an oral exam and a discussion of the pros and cons of appliance therapy. If they were a suitable candidate and decided to proceed with appliance therapy, we scheduled a visit for record taking and scheduled the patient for a baseline home monitor. On the third visit, we delivered the appliance and instructed the patient on its use showing them proper placement and removal methods. We also taught them exercises to help with TM pain, gave cleaning instructions and a morning after splint.

We have found the biggest challenge to compliance is making the appliance comfortable so we set up several weekly visits to stay on top of any teeth or jaw soreness. As they became comfortable, the patient was instructed to slowly advance the mandible until their snoring was eliminated. When that occurred, we sent the patient home with a home monitor. When their symptoms were better and AHI was below 15, they were sent back to their Sleep Physician for a follow up PSG. If they had not been fully treated, we had the patient advance the mandible to the maximum protrusion. At this point, they were retested, and if fully treated, referred back to their Sleep Physician. However, if they needed additional treatment, we initiated combination therapy and referred them back to their Sleep Physician for CPAP titration.

RESULTS: To measure my effectiveness, I sent out surveys to patients treated requesting information on their compliance: 327 were surveyed, 72% were male, 28% were female and 75% had been wearing their appliance between 3 and 10 years. Age-wise, 8% were 20-30 years old; 50% were 40-60; and 42% were 60+. Roughly, 58% of the patients anonymously responded (179): 62% said they wore their appliance every night; 13% wore it at least 4 nights per week; 11% had returned to CPAP; 4% had opted for surgery and 21% had decided against treatment.

CONCLUSION: Based on my survey measuring compliance and satisfaction, I found the TAP to be superior to CPAP when weighed against national compliance averages. Based on the recommendations of the AASM and the AADSM, TAP should be recommended as a first line treatment for mild to moderate OSA.