I want to address the issue around patients that are being treated today for Obstructive Sleep Apnea (OSA). Most patients today that see the sleep specialists and have been diagnosed with OSA are being treated with a CPAP machine. The purpose of this machine is to force air past the obstruction in the oropharyngeal airway and provide a better tidal volume of air to the lungs to assist the patient’s breathing during sleep. While the CPAP does work well with some patients, there are several issues with a CPAP machine that make it a challenge for some patients for a variety of reasons.
When PRECiDENT specialists treat a condition, it is important that treating dentists or physicians always remember that our goal is to treat — or at least offer to treat — the underlying cause of the condition and hopefully cure the disease or condition if possible. If we do not cure the underlying cause, then we become lifelong symptom treaters, like many of our friends in the drug world expect us to do today.
Many of us recognize that the probable underlying epigenetic creation of Obstructive Sleep Apnea is the underdevelopment and lack of proper growth of the maxilla (Upper Jaw) and mandible (Lower jaw) in children. Many of us are doing some great things with these growing children today to assist in that growth and development and seeing remarkable results. (More on that in a future article). Many dental appliances are making some mild anatomical changes in the adults that are helping with snoring and mild sleep apnea but do not provide a cure for these conditions. We must also remember that CPAP and or appliance therapy is also a symptom reliever and is not a cure for OSA. However, throughout the U.S. today the majority of patients that have Obstructive Sleep Apnea are treated with CPAP as the only offered solution.
Obstructive Sleep Apnea cases that truly have an anatomical airway that is not cured with minor treatments, and I would argue that CPAP is not necessarily a minor treatment nor a cure, have a potential cure if properly diagnosed, recognized, and treated properly. Surgical Airway Advancement Surgery is the only permanent cure for the OSA patient when done properly and if the anatomical airway is the primary cause. Why do I say that? In the non-growth potential patient, by advancing, expanding, rotating, and positioning the underdeveloped Maxilla and Mandible properly can permanently relieve the obstruction in the oropharyngeal airway passage. I have been doing these procedures for many years now. They are tremendously stable, and the physiological changes of the patients are very impressive.
As a profession, we are doing our patients a major disservice if we do not at least allow our patients to explore this option. Biased professional opinion against these procedures for whatever reason should not shield the patient from exploring both the benefits and of course the risk. I would also challenge our profession to realize that simply just because you may not offer these services in your practices, does not mean that the patient should not be sent for a consultation with someone that does, to see if they qualify for treatment. The reason I say this, is that I see so many patients all the time that say, I have been going to so many dentists and physicians for years, and why have they not offered me an option to see you.
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Surgical Advancement Airway Surgery is a legitimate option we must recognize more for the non-growing patient. It is the only option that has the potential to provide a lifetime cure for the Obstructive Sleep Apnea patient and possibly eliminate the CPAP.
Scotty Bolding, D.D.S., M.S.