Finding and Treating Sleep Apnea in Your Practice

Part 6 - Appliance delivery and follow-up

Instructors:

Dr. Kent Smith, DDS

Dr. Kent Smith, DDS

Kent Smith is the course creator and original instructor for Sleep Breathing Disorders at LVI Global, co-founder of the Dental Organization for Sleep Apnea and is on the Medical Advisory Board of Sleep Healers®. He writes and lectures internationally on obstructive sleep apnea and other sleep disorders.

Dr. Kent Smith demonstrates the delivery of the appliance and then walks thru the procedure for each of the follow-up appointments.

Okay. We're back 4 weeks later. We have the SomnoDent here to deliver to Kelly. So we're going to go over a few things with her. Again, we're going to talk about side effects because we talk about side effects at each visit. We don't want them to forget those. No surprises. Now Kelly we took a photo of your airway last time. If you recall and this is what your airway looks like. I called these the curtains right here on the side. That's the back of your through right there. We can barely see the back of your throat. The tongue rises up. Now your tongue is kind of covering over the teeth even. It's sitting on top of the teeth. It's a three car tongue in a two car garage. That's the problem. So that's taking up room. The uvula takes up some room and it even looks like, do you have any tonsils back there. Do you still have your tonsils? That's probably I don't know what that tissue is but anyway we're seeing not much at the back of your throat. So it's kind of like the curtains and the play. The curtains are almost close. Your play is almost over. Okay. Now this is what it's supposed to look like. See how much room there is there. So that's the problem. And what we're doing is we're bringing your lower jaw forward to create more room behind your tongue. So that's what this appliance is designed to do. Okay. Now when you were here first and you fill out all your information online, April then wrote all that information into the DentalWriter software. Each time you come in, you're going to come back in a week from that. We're going to deliver your appliance today but a week from now we're going to have you back in, see how you're doing with it and then a month after that. And we see you until we know you're in good shape. But each time, April fills out information in the DentalWriter software so it's going to take 10 minutes of time. You're going to fill out Epworth sleepiness scale each time you come in because we want to make sure you're getting less and less sleepy over time. A few things like that that we're going to be doing. But today is the big day cause this is when you're going to get your appliance. All right, now there are two segments to this and different appliances have different mechanism of action in the way they make the lower jaw move forward. This has wings as we described to you and the wings you can open and close and this keeps your jaw in the forward position even when you're open or close. But it doesn't allow you to open and get a drink of water and talk to Tony and you know, whatever you want to do. So the easiest way is to put the upper one in first. So if you'll place that for me. Just kind of push it into place. This usually fit perfect the first time. Okay. Now kind of bring your jaw forward like that and put that into place. There you go. It kind of snaps in. There you go. Okay. Now I want you to kind of lean back. And normally what we'll do is lean the patient all the way back and have them open and close and slide along the wings of the appliance. But you probably do that just like this. So slide up, open and close, open and close. There you go. Do they feel like they're hitting at the same on both side is the left hitting before the right or the right hitting before the left? About the same time. Okay. I know you may have, here's some paper towel in just in case you need to kind of wipe your mouth sometimes. Until your mouth figure out this isn't food, it wants to eat it. So it salivates more and yeah. So that will go away over time. Don't worry about it. Okay now when you bite is it an even bite. Do they come together at the same time? Okay. Perfect. All right. Well we don't want to make anymore adjustments. Now we've already got you in a protruded position. We will not make anymore adjustment at this appointment. We're going to wait until a week from now. Can you come back in a week to see us? Okay. We're going to see you back in a week. At that point we're going to find out how's that feeling. Are your joints doing okay? How's your bite feeling? Do you have any tenderness in your joints right now? No. You feel okay. Good. Good. Okay. Usually this position there's not but we still don't want you making any more adjustments. Now tonight you're not going to sleep all night and wake up tomorrow morning and say wow. I don't even think I had anything in my mouth last night. This is a massive acrylic. Okay. So if you can only wear for two hours the first night. Don't worry about it. Take it out. And we'll try more the next night. It's just important that we gradually acclimate. Some people do well the first night. Then you can wear it all night. But if you don't, don't worry about it. I'm not going to get upset at you. It actually helps sometimes if you'll put it in like 30 minutes before you go to sleep to try to get used to it before you lie down. If you just lie down then put it in, it might be hard to initiate sleep so do that about 30 minutes before and we should be okay. So I'm going to have April set up an appointment a week from now. You can go ahead and take that out. Now if you recall your bite may change. That was very easy. Yeah. It usually is. Now your bite may change. In the mornings when you wake up, now do you take a shower in the morning or at night? At night. Okay. So you're a little different. You can't really put gum. What we tell most people is to put gum in their mouth during in the morning shower. You don't do that then we have little tabs we're going to let you use to help kind of guard your jaw back into place. April is going to show you how to use those. And then you kind of just sit there and push out your jaw like this. You know just kind of wiggle it. Look for that spot. So you can do that as well. We also have a lower piece of material that we have you put in. It's kind of like a little tray that you bite into that reestablishes where you bite is. So I'm going to let April decides the best technique for you and we'll get that made for you so that when you come back you can let us know how that's going. All right, we want to know that. We're going to ask some questions about your fatigue again. How you jaw is feeling, all that kind of stuff. And then from that point depending on what you tell us a week from now we'll be telling you how to adjust it and moving further forward depending on how you're feeling and getting that silence that we've talked about in the past. Okay. All right. Well I'll get April in here to go over how to get your bite back into place in the morning and we will see you in a week. Okay. Great to see you. It's awesome. I mean it's better than what I even imagine. It's been a total life changer. I can put it in my mouth and when I'm ready to go to sleep I just drop off to sleep and I don't have to worry about making sure my water is in my tank from my CPAP or that I have everything pin and ready to go and if I wanted to sleep on my stomach I can sleep anyway I like. And then when I get up I refresh and I finally have that deep deep sleep that I've been really really wishing I had. So Kelly has been coming in over the last six months. She came in a week after delivery and then a month after. We've been having her adjust the appliance over time. We then send her home last time for a home study unit. She said she's feeling good and Tony says she's not snoring anymore. So we send her home with a home unit, came back, and it showed that we got excellent results. And so that's how we do this. The patient comes back in and at this point we kind of interview the patient sort of our reveal and they tell us how it's going. And then I'm going to be suggesting that she go a full polysomnogram after we know that she's in good shape. Without a doubt it has changed my life and I tell everyone if I know that they have sleep problems. Don't let them even say something to me like that and immediately I tell them about what I have done, what I found, and I would love for them to find the same thing. The term maybe has been used a lot but it is a win-win situation. Not only will you, by you helping your patients because the problem the majority of your patients are having some type of sleep disorder and more than likely it's sleep apnea. And then you can help touch their lives, save their lives possibly. And at the same time when you help benefit them in changing their quality of life to be the best then in return your practice will thrive and flourish as a result.