Obstructive Sleep Apnea

Obstructive Sleep Apnea-A Serious Problem with a Permanent Solution:

The trapping of the lower jaw, in addition to causing overbites and TMJ Dysfunction, can also lead to the serious medical condition of Obstructive Sleep Apnea (OSA). Dr. Lauson and Aurora Orthodontics have proven many times, with adult expansion of the upper jaw, that there is a possible, permanent solution for OSA.

So just what is sleep apnea?
 Apneas (meaning, “without breath”) are the result of pauses in breathing, and by definition, are when a secession of breathing lasts for at least 10 seconds.

Although there are many types of apneas, Obstructive Sleep Apnea (OSA) is by far the most common type and is the result of a blockage of the airway while sleeping. Snoring results from a partial obstruction of the airway and is the body’s early warning sign for the possible future development of OSA.

OSA Normal
Normal Airway
OSA Snoring
Snoring with Restricted  Airway
Obstructive Sleep Apnea

Illustration showing the developmental stages of OSA: Normal breathing; snoring as a symptom of a partial obstruction; and complete obstruction resulting in an apneic event (OSA).

Repeated apnea events throughout the night are classified as mild, moderate, or severe, depending on the age of the patient and the number of apnea events that occur per hour of sleep. Repeated pauses in breathing cause a reduction in blood oxygen saturation which has many negative effects on the body. Although OSA is typically thought of as a problem for middle-aged, overweight males, the truth is that OSA can, and does, exist in a very broad range of the population. Young and old, male and female, large and small, all have the possibility of OSA.

It is considered very serious if a child has even a small number of apnea events because of the immediate effect and the fact that the condition has grave developmental implications. Mouth breathing, behavioral and cognitive problems and hyperactivity have all been directly linked to childhood OSA. A child with a deep overbite and a retruded or recessed lower jaw has a serious, developing problem that needs correction by orthodontic/orthopedic means. If the narrow upper jaw and overbite are not corrected in an ideal manner, by enlarging the constricted upper jaw and freeing up the lower jaw to come forward into the ideal position, the die is cast for OSA. We as orthodontists have a unique opportunity to literally change a young patient’s future by treating with airway concerns in mind. Because OSA is a progressive disorder that intensifies with age, it is better to address these issues as early as possible, but also be aware that treatment for this disorder can be accomplished at any age.

Obstructive Sleep Apnea risks:

It has been well-established that OSA is related to serious conditions such as lowered immunity, obesity and cardiovascular stress, which can lead to strokes or heart attacks. OSA is also associated with many seemingly unrelated degenerative diseases, including pulmonary and systemic hypertension, diabetes and kidney disease and will rob a person an average of twelve years off his or her life. It is believed that hundreds of millions of adults suffer from OSA worldwide. Because of its widespread prevalence, it is a major global health problem.

“OSA does not have to be accepted as a condition a person just has to live with... The upper jaw can be expanded, and the lower jaw can be positioned more forward... This solution is effective and can significantly reduce, or even eliminate, OSA...Dr. Kent Lauson”

When a person suspects OSA, a sleep physician can confirm the diagnosis with an overnight sleep study. Once confirmed, the primary recommendation for a person with OSA is to use a continuous positive air pressure (CPAP) machine, which pushes air through a person’s nose, all night long, to give him or her much needed oxygen as he or she sleeps. This can work well for some, but a large percentage will become intolerant of its use and the machine then gathers dust in the closet, reducing the person’s chances for a long and healthy life. Oral appliances made by a dental sleep specialist can work well to relieve obstructive sleep apnea for many who are CPAP intolerant, but even these appliances can have their side effects causing problems with the person’s bite or the TMJ. A more comprehensive and permanent solution does exist.

A permanent solution to OSA?

Most people with OSA have a narrow upper jaw. The nasal airway can be compromised because the palatal bone, that is at the roof of the mouth, is the same bone that is on the floor of the nasal passageway. When the roof of the mouth is constricted, then the nasal airway is also constricted. This is the first of two choke-points that air has to pass through to get to the lungs. Also, this narrow upper jaw typically will cause the lower jaw to be recessed by trapping it in order to allow for comfortable occlusion of the teeth. The recessed lower jaw causes the tongue space to be reduced and the tongue has to more toward the back of the throat, the airway’s second chokepoint, creating the likelihood of Obstructive Sleep Apnea. This classic pattern exists in almost all people with OSA.

Now for the good news! These types of structural problems can be changed. OSA does not have to be accepted as a condition a person just has to live with (or die with). The case report for this article shows how an upper jaw can be expanded and the lower jaw can be positioned more forward. As you will see, this solution is effective for children and adults alike and can significantly reduce, or even eliminate, OSA, also allowing for a future life free of the dreaded CPAP machine! If this pertains to you, a family member or friend, do call our office at 303-690-0100 to schedule an evaluation. The life you save is important.

Case Study for OSA Permanent Solution:

When Bill came to see us, he was a 52-year-old man diagnosed with moderate to severe obstructive sleep apnea. He had been through a full sleep study and his oxygen levels during the night were recorded as low as 78%. This is significantly below the ideal of 92% or more. A CPAP machine was recommended and used, but after several weeks, Bill could not tolerate its use, so he came to us looking for a better solution. He knew that he had a serious condition that could end his life prematurely.

In our initial evaluation with Bill, we had discussed the option of a more permanent solution, an orthodontic/orthopedic treatment that we offered.

Our initial records show a constricted maxilla, dental crowding and right posterior crossbite. He had significant wear, especially on his front teeth. Extensive restorations, including two molar root canals, were present. Cone beam TMJ x-rays indicated osteoarthritic changes in his TMJs and restricted air flow in his throat.

Before Treatment
Photos taken before orthodontic/orthopedic treatment. Note the narrow arch forms.

Phase I orthopedic treatment

The purpose of the first phase of Bill’s treatment was to expand the upper jaw and the lower dental arch.

Note how the expansion of the maxilla and the lower dental arch shown in the next picture

Treatment post-expansion, prior to beginning Invisalign aligners.

Phase II orthodontic treatment

The final phase of treatment was accomplished with Invisalign™ aligners. Since one of our primary objectives of treatment was to allow the mandible (lower jaw) to close in a more forward position to increase tongue space (and eliminate the tendency for obstruction while sleeping, we elected to leave part of the space back of the upper cuspids). This would avoid a trapping of the lower jaw and allow a more forward positioning for it. This gives the tongue much more room to be more forward, a primary objective of our permanent solution for OSA. The Invisalign treatment was accomplished in the next 18 months for a total of 26 months of active treatment.

Completed Treatment
Completed orthodontic treatment photos

A physician’s sleep study Bill had showed night-time blood oxygen levels before and after treatment revealed a considerable increase from 78% before treatment to 92% after our treatment. The 3D x-rays revealed a 98% increase in airway volume from before to after.

Bill’s testimonial follows to elucidate the case for this type of treatment:

“In 2009, I went to see my Doctor complaining of severe fatigue. After completing an overnight Sleep Study with oximeter (my oxygen dipped to 78%), I was diagnosed with Sleep Apnea. For treatment I was provided a CPAP machine with additional feed of oxygen but could not adjust to it. I struggled for months trying to adapt. I never could sleep more than an hour before giving up and taking my mask off. My quality of life was taking a serious hit and I felt depressed. I didn’t see much of a future.

I had treatment with Dr. Lauson over a 2-year period. The results were fantastic! Without wearing a CPAP, or any oral appliance, I conducted an Oximeter test with a Sleep Apnea clinic and my oxygen level stayed above 92% the whole night. The Sleep Apnea technician reported to me that my apnea is under control and the treatment I had conducted with Dr. Lauson worked.”

Upper Arch
Upper arch before treatment compared to Upper arch after expansion treatment