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Treatment of OSA and Snoring

Friday, December 01, 2017

The American Academy of Sleep Medicine (AASM) now recommends oral applications such as EMA as a front line of treatment for snoring and mild to moderate sleep apnea, and in case where CPAP has not been tolerated.

The FDA has approved the EMA appliance for the treatment of both obstructive sleep apnea & snoring. This custom oral appliance is available to dental and medical professionals through authorized dental laboratories (go to myersontooth.com for a complete listing).

Step 1. Impressions & Bite Registration

A. Take upper and lower dental impressions. The extension should go to the height of the contour of the gingival on all sides of the teeth.

B. Send upper and lower models and bite registration or PVS impressions to an authorized EMA laboratory (go to myersontooth.com for a complete listing).

Step 2 Fitting Appointment

A. Seat the upper and lower appliance on separately without the elastic straps to check fit and comfort and to make certain there is no gingival impingement.

B. The EMA appliance may feel snug to the patient for the first 3 to 5 minutes. If patient complains of pressure or soreness on a tooth, carefully relieve problem area with a large bur.

C. Check the posterior bite pad for even occlusion. If either side is high, conservatively grind the high side until both sides occlude evenly in centric and a protruded position.

D. Remove upper and lower appliance.

E. Please see Yellow 21mm EMA elastic straps on the upper and lower appliances with the EMA logo facing the tooth side.

Hint: Moistening the EMA elastic straps and hot (not boiling) water will make it easier to attach them to the appliances. After the straps goes on the button, it may be necessary to rotate it to seal it properly.

F. Demonstrate to the patient how to insert the appliance correctly by seating the upper appliance, then having the patient move the mandible forward while pushing down on the anterior portion of the lower appliance until it snaps in place.

G. Instruct your patience to call the office the day after wearing the appliance for the first time. Commonly reported initial side effects result from mandibular repositioning including clenching, sore teeth, TMJ sensitivity, and increased saliva flow. The symptoms will abate significantly or resolved completely within 10 days.

H. Advise the patient to chew sugar-free gum every morning after wearing the appliance to help return condyles to normal position.

Step 3. Tertiary Care

The EMA appliance uses 9 different links of elastic straps to gradually and incrementally titrate (i.e. advance) for mandible forward. Four different strengths of elastic straps match the strength of pull to the musculature of the patient.

The four strengths are differentiated by color:
White = soft; Yellow = medium firm; Blue = firm; Clear = extra firm.

A. If the patient is experiencing soreness in both temporomandibular joints, instruct the patient to replace existing straps with the next softer strap (for example, replace Yellow 21mm with White 21mm).

B. If the straps are stretching out too quickly, instruct the patient to replace them with the next firmer straps (for example, replace Yellow 21mm with Blue 21mm).

C. Once you have determined which elastic strength is best suited for the patient, the appliance can be titrated according to the directions provided on the opposite page. The patient should replace the EMA straps whenever the holes in the straps are oval or when the existing strap is 1/8 inch longer than a new strap.

D. If the patient experiences pain in both TMJs, he or she should discontinue wearing the appliance and notify your office immediately.

Important: Patient diagnosed with OSHA will require a sleep study after you and the patient feel adequate treatment has occurred. The disappearance of subjective signs does not always translate to a successful treatment, especially with a diagnosis of OSA. Patients should consult their medical doctor and dentist to evaluate their condition to determine if a dental device is suitable for them. The patient's medical history, including a history of asthma, breathing or respiratory disorders, or other relevant health problems, should be considered in determining whether this device is appropriate. And oral appliance maybe contraindicative if any of the following apply to the patient: central sleep apnea, severe respiratory disorder, a history of TMJ problems, loose teeth or advance periodontal disease, or if the patient is under the age of 18. Patient should be aware that use of oral appliances may cause tooth movement or changes in dental occlusion, gingival or dental soreness, pain or soreness to the temporo-mandibular joint, obstruction of oral breathing and excessive salivation. The information provided herein is ¬-general and does not constitute advice and any specific patient case.