Dr. Barry Freydberg
A Report on a Creative OAT Solution for an Edentulous Patient. Dealing with edentulous OSA patients can be a challenge. Sometimes, if we’re fortunate, wearing the denture at night keeps the jaw forward and that’s all the patient may need to manage sleep apnea symptoms. We know that tongue-retaining devices can also work, but long-term compliance is very weak.
Presented here is an ideal oral appliance therapy for the mild or moderate OSA edentulous patient using the same principles as if she had a full dentition.
PATIENT HISTORY AND EXAM This patient was referred to my mentor Gene Mendelson, by a sleep MD after the patient refused CPAP therapy. Dr. Mendelson has been practicing dental sleep medicine for around 20 years and his work stimulated my awareness and desire to learn DSM. The patient is a 65 year old female with a BMI of only 19.4, She is 5 feet tall and weighs 100 pounds. Note that she does not fit the body type of the “typical (in most minds) sleep apnea patient”. This reinforces our need to not stereotype OSA patients as overweight when almost half are not. She has a history of airborne allergies and takes Lipitor, Vitamin D and Mirapex. Oral examination reveals a Mallampatti III, elevated hard plate, low draping soft palate infringing on her airway and minimal tongue room with lower denture in place. She complains of chronic jaw pain and says she is a chronic clencher. Palpation reveals her TMJ is tender bi-laterally and her right external pterygoid is tender to palpation, as are the left and right anterior belly PAGE
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