Phillip D. Wilson, D.D.S., assistant clinical professor in the University of New England College of Dental Medicine (CDM), is one in a team of authors of a clinical research report on oral appliance therapy (OAT) as an alternative treatment for obstructive sleep apnea (OSA), which was recently published in the Journal of Dental Research.

The report, “Randomized Trial of 2 Self-Titrated Oral Appliances for Airway Management,” compared two widely used oral appliance (OAs) designs and tested whether they differed in reducing the respiratory event index (REI) — a figure used to indicate the severity of OSA.

The randomized crossover study examined the differences in reducing REI between two oral appliances: the TAP1 and SomnoDent Flex. Due to design differences, the TAP1 device tends to restrict mouth opening during sleep, while the SomnoDent Flex allows for complete mouth opening. The goal of the research was to determine if these design variances had differing effects and if OAT was even effective in treating OSA.

To complete the study, participants used one dentist-fitted OA nightly for four weeks followed by a one-week washout period, during which participants were instructed to use their CPAP machines instead. This washout period was followed by a second four-week trial during which participants used the alternate OA.

Individuals received training on how to titrate each appliance and were instructed to advance their mandibles based on each manufacturer’s guidelines if they observed any snoring, OSA events, or persistent daytime sleepiness. To measure REI, home sleep recordings were collected using the NOX T3 recorder, and oxygen saturation was measured with a finger probe pulse oximeter.

After nine weeks, the researchers found that both devices demonstrated equivalent REI attenuation regardless of jaw-opening limitations, and both designs significantly reduced the REI in adults with moderate and severe OSA. These findings were somewhat surprising because the current understanding is that OAT was only effective for those suffering from mild OSA, Wilson said.

“When self-titrated over a short period of four weeks, the results suggest that both designs improve upper airway function and stability, reduce its collapsibility, and increase oropharyngeal space,” the team wrote. “Collectively, our data suggest self-titrated OAs can be routinely offered as a treatment option for OSA patients, and clinicians can expect about a 50% response rate and to bring the REI down to about eight to 16 events per hour after eight weeks among patients, including those with severe OSA.”

Read the full article at journal of dental research

World Orthodontic Health Day is celebrated on May 15, the General Council of Dentists recalls the multiple benefits of the use of orthodontics for our health and quality of life.

To complete the study, participants used one dentist-fitted OA nightly for four weeks followed by a one-week washout period, during which participants were instructed to use their CPAP machines instead. This washout period was followed by a second four-week trial during which participants used the alternate OA.

Individuals received training on how to titrate each appliance and were instructed to advance their mandibles based on each manufacturer’s guidelines if they observed any snoring, OSA events, or persistent daytime sleepiness. To measure REI, home sleep recordings were collected using the NOX T3 recorder, and oxygen saturation was measured with a finger probe pulse oximeter.

After nine weeks, the researchers found that both devices demonstrated equivalent REI attenuation regardless of jaw-opening limitations, and both designs significantly reduced the REI in adults with moderate and severe OSA. These findings were somewhat surprising because the current understanding is that OAT was only effective for those suffering from mild OSA, Wilson said.

“When self-titrated over a short period of four weeks, the results suggest that both designs improve upper airway function and stability, reduce its collapsibility, and increase oropharyngeal space,” the team wrote. “Collectively, our data suggest self-titrated OAs can be routinely offered as a treatment option for OSA patients, and clinicians can expect about a 50% response rate and to bring the REI down to about eight to 16 events per hour after eight weeks among patients, including those with severe OSA.”

What conditions can gum surgery treat?

Periodontal surgery can treat many conditions, including gingivitis. Gum diseases such as gingivitis and periodontitis may require surgical treatment.

Gingivitis is a mild form of gum disease that can cause gum redness, swelling, and bleeding. Most often, gingivitis occurs due to poor oral hygiene, plaque, and tartar buildup. Professional treatment can reverse the condition.

Periodontitis is a more severe form of gum disease in which gingivitis has worsened and advanced, leading to an inflammatory response that destroys bone and tissues.

During this inflammatory process, the gums begin to separate from the teeth. This causes spaces called pockets to develop, which in turn trap bacteria and lead to infection.

Types of surgical procedures

Which kind of surgery a dental surgeon performs depends on the type and severity of the gum disease.

Before surgery, a dental surgeon might give the gums a deep clean. One procedure known as deep scaling can remove tartar and bacteria from teeth and gums.

Another procedure known as root planing can smooth the surfaces of the roots of the teeth, meaning that there are fewer places for tartar and bacteria to build up. This procedure also removes any tartar that is on the root.

Deep scaling and root planing usually occur at the same time.

Flap surgery

Flap surgery is especially helpful for people who have tartar deposits in deep pockets. The procedure involves lifting the gums off of the teeth to remove tartar buildup.

After the surgeon has cleaned the area and removed the tartar, they will stitch the gums into place to fit around the teeth. Sometimes, the bone may require reshaping during this procedure.

Bone grafting

When the bone that surrounds the root of the tooth is damaged or destroyed, a person may need a bone graft. This procedure involves replacing the damaged bone with new bone. This bone may be the person’s bone, a manufactured bone, or donated bone.

The goal of bone grafting is to hold the tooth in place and help it to regrow.

Guided tissue regeneration
During this procedure, a dental surgeon will place a small piece of mesh-like material between a person’s bone and gum tissue.

The material prevents the gum from growing into space where bone should be, allowing the bone and connective tissue to regrow.

Tissue grafting

The type of surgery performed will be based on several factors, such as the condition of the gums.

A lowered gum line, known as gum line recession, is caused by the loss of gum tissue and may require soft tissue grafting to reduce the risk of further damage.

During this procedure, a dental surgeon typically removes tissue from one part of the body and re-attaches it to the area where the gum has receded. The tissue often comes from the roof of the mouth.

Tissue grafting not only reduces the risk for further damage but also covers any exposed roots.

Other treatment options include:

Laser therapy: Although no current evidence fully supports laser therapy, some dentists use it to reduce the size of pockets and restore damaged connective tissue.

Tissue-stimulating proteins: This procedure involves using a protein-containing gel to stimulate bone and tissue growth.

Preparing for gum surgery

Before a person has a gum surgery, a dentist will perform a pre-operative exam to make sure it is safe to have surgery.

During this exam, the dentist will likely:

• Take a medical history review and do an exam.
• Examine the teeth, mouth, and jaw to check for stability and health.
• Check for any infections, abscesses, or other lesions that could make healing from surgery more complicated
• Discuss the risks and benefits of the operation, and receive permission or consent to move forward with the surgery
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• What happens during surgery
• Depending on the type of procedure, a range of things may take place.

Most gum surgery procedures take around 2 hours to complete.

In some cases, the surgery will require a person to be asleep or partially asleep during the procedure. Other times, the surgery only involves the use of a local anesthetic to numb the gums. The injection of the numbing medication can be mildly uncomfortable.

During the procedure, the dental surgeon uses sterile equipment, including instruments and drapes, to lower the risk of infection.

After making small incisions or cuts along the gum line, the dentist will lift the gums away from the teeth. This allows the dentist to see the roots better so that they can remove and clean away any tartar, plaque, or infection.

Following this deep cleaning, the dental surgeon can perform other procedures, such as gum reshaping, bone regeneration procedures, or other planned procedures.

Once the planned dental surgery is complete, the surgeon will stitch the gums back into place, using fine thread stitches. The dentist will remove the stitches 7 to 10 days after surgery.

Recovery

Antiseptic mouthwash may help to prevent infection after surgery.

Following any dental procedure, a dentist will provide detailed instructions on how to achieve the best possible recovery. Recovery times will depend on the extent of the procedure taking place.

Typically, people will require pain relief medications in the days after gum surgery. Again, the dentist will talk to the person about any recommended drugs before they leave the office or surgical center.

Dentists may also recommend:

• Using an antiseptic mouthwash to keep the area clean and to avoid infection.
• Avoiding strenuous exercise.
• Eating soft foods in the days following surgery.
• Not smoking.

The dentist will schedule an appointment to return to the office for 1–2 weeks time. During this appointment, the surgeon will check how the gums are healing and, if required, remove any stitches.

A person’s gums will look and feel different after surgery. The gums and teeth will heal, tighten, and become firmer and stronger. Some people may have tooth sensitivity to hot or cold temperatures and may find relief by using desensitizing toothpaste.

Dentists will discuss a follow-up schedule to maintain good oral health in the future.

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