welcome to episode 75 of chairside live Megan how do you feel today I'm not here neither am i
we are both gone we are taking off a little bit of time our traditional post-halloween vacation
that we take together to go survey pumpkins of the world no actually I'm going fishing and therefore
we decided not to do an episode this week but the viewer is the real winner it's a win-win it's win
win win win for me i'm on vacation win for you you don't have to write any news and win for the
viewer is they get to see a special excerpt from a special DVD one of my dreams came true this year
when Gordon Christensen called me and asked me to come up to provo and make one of his famous
PCC DVDs with him on snoring and sleep apnea and I was thrilled to do it and went up there we had an
opportunity to make this introduction to snoring and sleep apnea i'm going to highly suggest you
purchase this DVD if you're not currently treating these patients and if you say well I don't have
any patients who snore Oh have sleep apnea in my practice i'm here to tell you that's just not true
and the way i identified these patients i added one question to my health history so when patients
would come in and update it it was a question that said are you interested in a non-surgical
way to stop your spouse from snoring yes and so yeah I know you are as we've made your husband
and appliance and the truth is for every 10 women who see that and fill it out ate literally seven
or eight of them will put yes I'm interested in a non-surgical way and the other two or three
put I don't care if it's a surgical way I don't care what you have to do you can even lop his
head off if that's going to work whatever works and whatever stops it and so I didn't originally
just to see what the interest was and kind of get on the good side of the women in the practice but
as it turns out it helps not only the women but it helps the men to men who are you know
driving to work and falling asleep driving home and falling asleep they're just always in a bad
mood because they've never slept through the night for the last 15 years and for some of these guys
when you're able to address their sleep apnea they start sleeping through the night and know
they'll tell you this is the first time I felt good in the last 15 years I forgot what it was
like to feel good because I felt cruddy for so long I've seen men in years I've gotten hugs for
men if you're uncomfortable getting hugs from men you may not want to incorporate this into
your practice because a lot of the time it is men that we're dealing with an a few women as well but
predominantly it's men that we treat so it's a very rewarding part of a dental practice it's
one of these areas that slips between medicine and dentistry where nobody's really taking care
of it and as much as we love our Oprah moments and dentistry when you put new veneers on someone and
you show them the mirror and they tear up and they start to cry like it was extreme makeover you're
going to find that happens a lot more with sleep apnea these are patients who not only look better
the circles under their eyes go away you know things start to clear up in their face and they
just look different but they feel fantastic and that's really one of the greatest gifts that we
can give any patient so when I went up there and made this DVD with Gordon sense as a laboratory we
make so many of these appliances in fact we make over 25,000 just silent night appliances a year
and so I want Dennis to get a feeling of hey this is there's a lot of dentists doing this that make
up for those 25,000 plus appliances that we do so I'm going to suggest that you go ahead and order
this DVD I'll have James put the information right down here on the monitor Thank You Megan and this
is something you want to get involved with its it's easy dentistry in the psyche all it thinking
man's dentistry and I don't want to blow it up too much but it's an area of Dentistry where you
don't have to give somebody a shot you don't have to use a handpiece and drill on their tooth so if
your back starting to go bad it's it's just a nice way to be able to do it you get good reimbursement
through medical insurance for these appliances and really it's just a great way to get on the side of
women who want their spouses to stop snoring and of the men who have sleep apnea go a step
beyond that and really help them to feel better so Gordon and I had the opportunity to do this DVD
and one of the things that we spent a lot of time talking about was appliances because in addition
to the four or five that we make here there's probably over a hundred appliances available
worldwide so we looked at the most common ones and that's what this episode of chairside live
is going to be for you today that excerpt from the DVD I hope it whets your appetite I hope it
gets you excited to start treating these patients and I it gets you excited enough to order the DVD
take a little deeper dive into snoring and sleep apnea and see it this is a part of Dentistry that
you'd like to get involved with well Gordon I've decided to bring believe it or not a small sample
of the appliances that are available but it's pretty obvious why this would be intimidating
to the average dentist right totally confusing because they all do about the same thing they
do and so really this is like you know coke and pepsi and Shasta these are all different flavors
of essentially the same thing but there's no little differences between some of them and so
it's kind of worth pointing out what they are but I don't want any the dentists to look at
this and think to themselves do I really need to know everything about all I don't know anybody
there's no way every one of them is the best it's like products we evaluate every one is the best
well let's let's get going all right well that first one you're about to pick up is the clear
way appliance and like most of them this allows 10 to 11 millimeters of advancement you can see
we've got the hardware in the palette but if you try to open those two apart you'll see they
really don't come very far apart so that for one of those ones for a patient with a BF tea with a
big fat tongue that's going to make them feel claustrophobic they're not going to like that
its thermal plastic on the inside so this can be heated up put into hot water patient puts in their
mouth and bites into it which is nice but it's a major mouthful I can't imagine having that that
big of a thing and while you put an l like but I'm not going to put it in the Canadian government has
tested that a lot it's got a seventy-eight percent success rate so it does work again
where people aware things an EMA appliance this is uh look like you could wear that in your mouth
probably absolute little wet that one small yep easily adapted I can see easy to titrate you
can actually send you'll notice there's a bag of bands of different durometer xin different
lengths so this is one where the patient's not coming back to the office for adjustments if
they continue to snore they put different length arms shorter and shorter arms on so they can
titrate it themselves at home till their partner reports that they're no longer making any noise
that's highly desirable for someone living a long ways away exactly and you can see that that would
probably be its low profile probably a good store device to get somebody used to I insist right now
this is the herps it's been used as a functional appliance for a long time in orthodontics and it
was realized that wait we can move the mandible forward as well like we were in these class to
patients and you can probably see that it's pretty strong you know these are pretty good connectors
but even some really strong bruk sirs can break those screws off of there and if you go to open
that one to see how much the patient can open they can open wide so that's a very comfortable
appliance they can open wide they can jaan but the problem is in some patients when they're sleeping
their mouth will fall open because it has so much freedom and that's why you can put vertical
elastics here to keep their mouth and there there's so much hardware on the side I can see
a side sleeper would feel like they had a barbed wire and there's absolutely everybody feels when
they get ortho bands on for the first time right on that is a tap elite tap is one of the premier
OSA appliances been around for a long time three or four different versions of it probably the most
tested if you look at the research the most tested device that we have out there so lined typically
with thermic Rilla on the inside so again it can be heated up in water and put into the patient's
mouth which is nice in case they have a composite done some of the hard acrylic ones won't fit back
in place you can heat these up put it in it fits very tight it adapts because of it shrinks kind
of around the tooth as it cools we have patients getting a hot shower and rinse their mouth with it
and take it out in the shower because we like it to be that tight and again the turning you
were doing right there a quarter millimeter with each turn patient can do that at home nice oral
appliance for patients with obstructive sleep apnea and some that gets approved by medical
insurance all the time this is a dorsal appliance and as you put those two pieces together it looks
like Dracula looks like something while I so he does yeah like that way that looks and as you put
those together again it's the same thing we're moving the mandible forward lot of space in the
front doors you open it up you can see for the tongue but if you try to go side to side not a
lot of movement there so this is a good one for a slight a side sleeper they can't get very far
when they try to do that and smooth without a Larry burger the hardware is all contained in
here the only issue as you might guess is because we have a bilateral adjustment here if the patient
loses count and gets them off in exactly now we've done a pain symmetric manda lets me crazy look at
this appliance that's the Oasis this is the only appliance that's been reviewed by the dental and
the ENT divisions of the FDA so it's actually been approved for a snoring for obstructive sleep apnea
and nasal resistant so you'll notice these nasal die layers it's like a built-in breathe right
strip and so it goes in underneath Aaron literally dilates the nose so if there's an obstruction
there because of a polyp or something else it will move that as well we've got some tongue
training tabs on there as well and so that again appears to be a mouthful but this is the only one
that really kind of takes into consideration the fact that we might have some nasal obstruction
and that's what makes it a nice one to do a little different this is one that I'm familiar
with visits from Glidewell labs this is the silent night with the new slightly connectors on here and
very popular it's been very popular because you know again it's a low profile one there's not a
lot of hardware there it's an easy appliance to put into place it's got a hard outer layer soft
inner layer so it's very comfortable I know some people who when they're going to put a patient in
something maybe like a herbst they will start them in this just to get them kind of used to wearing
out appliance and and seeing what it feels like to have something in their mouth this is a full
breath appliance this is from space maintainer laboratories down in Southern California and this
is the only one as you notice all of these this is the only one you'll see that's FDA approved
for treating obstructive sleep apnea that's a single arch appliance all these other ones upper
and lower mouthful this one just is on the lower and then you add some acrylic here I think you've
been playing these a little round we've been evaluating at NCR with good success and I'll
report on it in a few minutes when we're finished with this overall view this one obviously pushes
the tongue down but you have to keep adding adding adding we'll talk about a little later right so
not not necessarily a great appliance for gaggers necessary I do want to point out one thing though
bass maintained errs has done a great job and put together a laminated chart that really has
well it has all the appliances they do but they do an awful lot of them and it's really nice of
them to go through and do this as you know we get zero hours of education Oh in dental school
when it comes to this and so the labs that get into these types of appliances on you know they
really have to do a lot of work to kind of bring us bring the dentist up to speed they do this is
another one from space maintainers to sleep well appliance good entry level device you can see the
mandibular advancements actually done by a little insert that slides in there on the maxillary and
so it's got different differing levels of bringing the mandible forward and again it's pretty simple
it looks like an ortho retainer essentially on the top and it looks like a thick you know essex
retainer on the lower and so really that's y i'm pretty minimal to put in somebody's mouth
and have them and have them hopefully be able to adapt well to it this is an exciting one this
is the the newest and latest and greatest from Great Lakes orthodontics another company who's
dedicated to making orthodontic and obstructive sleep apnea appliances and they do a great job
with education too if you go on their website lots of good videos this is the narwhal it's a CAD cam
appliance I look at that this material is so light wrong a fantastic almost all these other ones will
pick up stains and smells and this one will not you know it's printed from a CAD cam process it
fits so tightly that they don't even have to contact the anterior teeth so on most of these
as you can imagine when you pull that mandible forward and it wants to go and it's pulling back
like this it wants to retro Klein the maxillary incisors and pro Klein the mandibular ones and
that doesn't happen on the narwhal because of the fact that it doesn't contact the anterior
teeth on the upper or the lower are you confused these are as Michael said previously I could
make a car analogy forged Chevy's and similar cars they all do the same thing except this one
which holds the tongue down we'll discuss maybe that is an alternative for someone who cannot
have the mandible move forward without some side effect in the temporomandibular joint well this
has been an excellent overall view of how many we were talking the other day how many do you
think there are overall internationally there's a hundred I could watch that forever Gordon and
I on DVD together it's like for me I like I said it's a dream come true and I should just put that
on constant loop in my office upstairs just always playing or maybe the front desk of the
lab no but that constantly playing did you learn anything I did I learned a lot and I'm even more
grateful now for the science because it really has improved my husband's life and then mine as well
exactly and now that you see there's 15 different appliances we can make for him as well we started
with what we consider to be the most comfortable one the silent night but it's certainly not the
more robust some of those other ones you could drive a tank over and so if he breaks his or
the dog continues to chew through it we might have to go something more substantial if the
dog tries to chew on a little break all your little puppies teeth out all right now about
wrap it up for this episode this very special episode of chairside live on behalf of myself
Megan dr. Gordon Christensen the CSL crew and everybody here at the lab I want to thank you
for your time and your continued commitment to quality dentistry we'll see you next time
you