Oral Care Advice

Finding the right surgeon for you can be a challenge in any situation, but finding the right sleep apnea surgeon can be even more challenging since there are so many different procedures and there are no standard operations. I’m asked quite often by people in other states or other countries who they should go see to treat their sleep apnea condition, and over the years, I’ve come up with the following 10 thoughts and tips. These are suggestions that I would offer to a friend or relative in a remote state if they asked for my advice.

In most cases, an ENT surgeon will be the most appropriate person to see, as they are most qualified to perform surgical procedures of the upper airway. By definition, ENTs (otolaryngologists) are trained in plastic and reconstructive surgery of the soft tissues of the head and neck region. They are the specialists that other doctors call to manage complications of the upper airway. However, there are situations where oro-maxillo-facial surgeons and general plastic surgeons may also play a role.

1. Did you exhaust every other possible option for sleep apnea? Did you try CPAP? How much effort did you put into making sure you gave CPAP a chance to work? Did you consider dental appliances? A good surgeon doesn’t rush into surgery without trying conservative options first.

2. Can you breathe through your nose? Having a stuffy nose can definitely prevent you from benefitting from either CPAP or dental devices. Often, after optimizing nasal breathing via medical or surgical means, people are able to use CPAP or dental devices more effectively.

3. Make sure the surgeon is confident to a reasonable degree where your obstruction is happening. Performing major surgery to “see what happens” is not a reason to do surgery. There are three major areas: the nose, the soft palate and the tongue. The surgeon must be comfortable operating in all three areas. How thoroughly do they examine your upper airway? Do they look with the fiberoptic camera with you sitting up and lying flat? Do they look for movement of the space behind the tongue by having you thrust your lower jaw forward?

4. Can they give you their success rates and complication rates? What is their definition of success? What are their long-term success rates? Compare this with current success rates for uvulopalatopharyngoplasty (UPPP), which has published success rates around 40%. Multilevel surgery approaches around 75 to 80%.

Can they honestly give you their complication rates? If they have no complications whatsoever, I’d be suspicious. Are they prepared to handle anything that may arise? Ask what his or her last complication was and how it was managed. It may seem counterintuitive, but if they don’t have any experience managing complications, you don’t want to be the first one.

5. Do they have a plan in case the surgery doesn’t work as planned? If the post-op sleep study shows less than a significant drop in the AHI score, what are your options? This should be discussed before your initial surgery. Do you stop there, or do you go back and do more (if there’s an obvious area to address), or do you go back to CPAP? Is a referral to an oro-maxillofacial surgeon an option?

6. Don’t focus too much on volume of cases. What’s important is how well it’s done and the appropriate location of the procedure, rather than total number of cases performed. Thousands of UPPPs alone are performed every year by surgeons with only a 40% success rate. If this is the only operation that’s offered, without a plan to address the tongue either simultaneously or at a later point, then your chances of success is no better than 40%.

7. Do they use the Friedman staging system? This is a simple screening tool where by looking at the size of your tonsils and your tongue position, you can predict whether or not a UPPP alone can have an 80% chance of success. Most people will fall into the “unfavorable” category, but if you meet the “favorable” criteria, a UPPP alone may be a good option, as long as you understand that there’s still about a 20% chance of failure.

8. How comfortable are they performing tongue base procedures? Do they have experience with multiple procedures or are they very good at just one? Are they able to perform any of the minimally invasive tongue base procedures in addition to the standard techniques?

9. How well do they work with your sleep doctor and/or dentist to coordinate your care? Is he or she willing to combine multiple treatment options if necessary? Sometimes dental devices or surgery can make CPAP more tolerable by lowering the necessary pressure.

10. Do you trust your surgeon? You must be comfortable and have a good rapport before you undergo any invasive procedure. Get second or third opinions. No matter how technically skilled the surgeon is, if there’s no bedside manner or if the staff is rude, it will eventually show in the quality of your care. As with any doctor, the focus must be on you as a whole person, rather than an isolated surgical procedure.

As you can see there’s no one best solution for treating sleep apnea. There are general recommended guidelines and conservative options must be tried before surgery, but even with surgery, many different paths can be taken, since every patient is different with individual needs. If you’re considering surgery, find someone that you’re comfortable with, and develop a good relationship with that surgeon.

For many people, snoring unfortunately goes hand in hand with sleep. While it used to be that most snoring treatments were available only through medical channels such as ENT specialists or overnight sleep clinics, these days, many people are turning to their dentists for help in coming up with effective snoring treatments.

What kind of snoring treatment can your dentist provide?

Snoring is caused by a narrowing of the airway, which prevents the sleeper at hand from breathing as smoothly as he should. Many dentists offer snoring treatment in the form of oral appliances that are worn in the mouth during the night. These appliances are designed to maintain an unobstructed airway in the mouth and throat so that the patient can breathe normally while he is asleep, and therefore stop snoring. Many different types of oral appliances are available, so a dentist who specializes in snoring treatment will work with the patient to find the device that is the most comfortable and effective.

Snoring treatment can take several weeks or several months to complete. Anyone beginning treatment should be prepared to schedule a number of follow-up visits with the dentist so that he can monitor the treatment and assess the effect of the oral appliance on the teeth and jaw.

In certain cases, an oral appliance might not successfully treat the snoring problem at hand, and additional procedures might be required. Dentists who specialize in snoring treatment tend to be quite good at keeping the comfort of the patient in mind, and will usually try the least invasive approach when attempting to treat the problem.

Who needs snoring treatment?

Statistically, up to forty percent of adults snore for several nights during week. Snoring can interrupt an otherwise restful night of sleep, which, in the short term, can cause fatigue and irritability the following day. Over time, improper or inadequate sleep can catch up with you and cause some more serious long-term health problems.

Snoring has been associated with an increased risk of certain medical conditions such as hypertension and cardiovascular disease. It is also a primary symptom of sleep apnea, a serious condition that should not be ignored. Even without sleep apnea, snoring can lead to numerous health problems.

If you are the type of person who snores as a side effect of congestion, cold, or allergies, then the problem will probably resolve itself once your body recovers. However, if you are a consistent snorer, then seeking out treatment is highly recommended. A dentist who specializes in snoring treatment can help you achieve a more restful, quiet night’s sleep.

Benefits of snoring treatment

The primary benefit of snoring treatment is a better night’s sleep for you and those around you.

If you are a snorer, don’t forget about the innocent victims of your snoring, otherwise known as your partner sleeping beside you, or, in extreme cases, your roommates who can hear you snoring through the walls of your apartment.

Most medical professionals will be quick to emphasize the importance of a good night’s sleep. By getting snoring treatment, you can improve your sleeping patterns which, in turn, will improve your health overall.

Many people who snore tend to be embarrassed by the condition and often avoid overnight situations that include the company of others. The proper snoring treatment will eliminate this issue so that your snoring will not inhibit you socially or prevent you from doing the things you want to do.

The downside of snoring treatment

Most medical treatments come with side effects, and snoring treatment is no exception. The oral appliances used to treat snoring can cause a gradual shifting of the teeth over time, which, in turn, can result in an uneven bite. In most cases, the movement of the teeth is not visible, but the patient might be able to feel the difference in his bite. Some oral appliances have also been known to cause initial gum irritation. With a variety of oral appliances available for snoring treatment, your dentist can work with you to choose the one that causes the least amount of discomfort.

The bottom line

Eliminating snoring will result in a better night’s sleep for you and for those around you. With all of the minimally-invasive snoring treatments available, it makes sense to visit a dental specialist to review your options. After all, sleep is a precious gift, and you might as well make the most of it.

The information in the article is not intended to substitute for the medical expertise and advice of your health care provider. We encourage you to discuss any decisions about treatment or care an appropriate health care provider.