FIRST COAST ORAL SURGERY
Andrew Skigen, DMD, FACS • Anthony Massaro, MD, DMD
Sepideh Sabooree, MD, DMD • Stacey M. Nedrud, MD, DMD, FACS
Diplomates of the American Board of Oral and Maxillofacial Surgery
Fellows of the American Association of Oral and Maxillofacial Surgeons
Obstructive Sleep Apnea
What is Sleep Apnea?
The incidence of obstructive sleep apnea (OSA) is approximately 24% in men and 9% in women. Individuals who suffer from OSA have disrupted sleep and low blood oxygen levels. When obstructive sleep apnea occurs, the upper airway can be obstructed by excess tissue, large tonsils and/or a large tongue. This stops airflow to the lungs, depriving the circulation from adequate oxygen. When the oxygen level in the brain becomes low enough, the sleeper partially awakens, the obstruction in the throat clears, and the flow of air starts again, usually with a loud gasp. This cycle repeats itself many times during the night and may result in sleep deprivation and a number of health-related problems.
Examples of such serious health problems include memory loss, depression, hypertension, erectile dysfunction, stroke, cardiovascular dysrhythmias, myocardial infarction, and sudden death.
Sleep apnea causes excessive daytime sleepiness. People with sleep apnea are 10 times more likely to die in a car accident than someone without sleep apnea. People with OSA can also suffer from memory loss, poor judgment, loss of concentration, depression, headaches and decreased mental function.
Dr. Skigen specializes in the treatment of obstructive sleep apnea. The first step in treatment resides in recognition of the symptoms and seeking appropriate consultation and diagnosis. To determine the severity of your sleep apnea, a sleep study, or polysomnography, will be recommended. This is a special overnight test that monitors your nighttime sleep patterns and gathers data about the number and length of each breathing cessation that disturbs your sleep. There are several sleep centers in the Jacksonville area where this can be performed; our office will be happy to assist you in scheduling your sleep study if necessary.
In addition to a detailed medical history, the doctors will perform a head and neck examination looking for problems that might contribute to sleep-related breathing problems. Anatomical features which can contribute to OSA may be the airway muscles which collapse during sleep, the nasal passages which may be narrow and the position of the upper and lower jaw. Dr. Skigen will assess the anatomic relationships in the maxillofacial region using cephalometric analysis and three dimensional reconstruction of your airway anatomy. Sometimes a naso-pharyngeal exam is done with a flexible fiber-optic camera.
Treatment for Sleep Apnea
Treatment Options
There are several treatment options available, depending on whether your OSA is mild, moderate or severe. Non-medical treatment such as weight loss, change of sleeping position, as well as avoiding alcohol, caffeine and heavy meals within 2 hours of bedtime can improve your symptoms.
Nasal CPAP (Continuous Positive Airway Pressure) is considered the first line treatment for moderate to severe sleep apnea. CPAP delivers pressurized oxygen through a nasal mask to limit obstruction at night. CPAP can effectively treat sleep apnea but it does not cure OSA as the efficacy of CPAP is dependent on use of the machine every night. Some people complain of nasal congestion, throat dryness, eye irritation, mask discomfort and hissing noises from use of their CPAP machine.
Oral Appliances are a non-surgical treatment option for patients who do not tolerate CPAP. The appliance is placed in the mouth at night to hold the lower jaw and tongue forward. This elevates the soft palate and prevents the tissue collapse over the airway. There are several appliances on the market. Dr. Skigen will determine which appliance is best suited for you.
The most successful surgical treatment option for OSA is maxillomandibular advancement surgery. The bones of the upper and lower jaw are brought forward to increase the size of the airway. This procedure is done in the hospital under general anesthesia and requires a one to two day overnight stay in the hospital. Surgical plates and screws will be used to hold the upper and lower jaw in their new positions, avoiding the need to have your jaw wired shut. All incisions are made inside the mouth to avoid unwanted scarring. Pain after surgery is easily controlled with medication and most patients return to work within 2 weeks.
Every patient Dr. Skigen has treated for sleep apnea has noticed a significant improvement in their snoring and breathing immediately after surgery!
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How Many Implants Do I Need?Most frequently, one implant per missing tooth is placed. Because many of the larger teeth in the back of your jaws have two or three roots, the most common approach is to replace missing back teeth with larger implants.
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What will I use for teeth while the Implants heal?Many options are available, and they are tailored to your specific requirements. If you need a replacement tooth while the implants are healing, temporary removable teeth or a temporary bridge can be made. If all of your teeth are missing, we can usually modify your present complete denture or make you a new temporary denture. If you would prefer non-removable teeth during the healing phase, temporary transitional implants usually can be placed along with the permanent implants, and temporary teeth may be made and inserted the same day. Depending on your particular situation, some implants can be placed and “loaded” immediately. This means a temporary or permanent replacement tooth can be placed on, or shortly after, the day the implant is placed.
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What are the potential problems with Implants?Although it is natural to be concerned about the pain that may be caused by these procedures, most patients do not experience severe or significant post-operative pain. Pain medication and antibiotics will be prescribed for you to make your recovery as easy as possible. Occasionally, some people develop post-operative infections that require additional antibiotic treatment. Even though great care is taken to place the implant precisely, occasionally adjacent teeth are injured in the placement process. In addition, there is a chance that the nerve in the lower jaw, which provides sensation to your lower lip and chin, may be affected. If you are missing quite a lot of bone, it might be difficult to place an implant without infringing on the nerve space. Although we take great care to avoid this nerve, occasionally it is irritated during the procedure, resulting in tingling, numbness or a complete lack of sensation in your lip, chin or tongue. Usually these altered sensations will resolve within time, but they can be permanent and/or painful. If you notify us of post-operative numbness as soon as possible, it will allow us to manage your care in the most appropriate way.
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How long will Implants last?Implants usually last a long time. When patients are missing all of their teeth, long-term studies (more than 30 years) show an 80 to 90 percent success rate. For patients missing one or several teeth, recent studies show a success rate of greater than 95 percent, which compares favorably with other areas in the body that receive implant replacement (such as hips or knees). However, if one of your dental implants either doesn’t heal properly or loosens after a period of time, you may need to have it removed. After the site heals (or on occasion at the time of removal), another implant usually can be placed.
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When are the replacement teeth attached to the Implant?The replacement teeth are usually attached to the implant when adequate healing has occurred and your jawbone is firmly fused to the implant. Depending on a variety of factors, it may be possible to begin this phase of your treatment immediately or shortly after implant placement. We will review the most appropriate treatment sequence and timing for your particular situation. The dental work required to complete your treatment is complex. Most of the work involves actually making the new teeth before they are placed. Your appointments are considered more comfortable and more pleasant than previous methods of tooth replacement. Frequently, this process can be performed without local anesthesia. Your restorative treatment begins with specialized impressions that allow us to produce a replica of your mouth and implants. We will also make “bite” records so that we see the relationship of your upper and lower jaws. With this information, we will make the abutments (support posts) that attach your replacement teeth to your implants. Various types of abutments exist. Frequently, we can use “off the shelf” abutments. Other times, custom abutments must be made of gold or a tooth-colored ceramic material. As you can imagine, these custom made abutments add to the cost and treatment time involved. Which abutment to use is a decision that often cannot be made until after healing is complete and impressions have been made.
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How do I clean my Implants?As with natural teeth, it is important that you clean implant-supported restorations regularly with toothbrushes, floss and any other recommended aids. You should also visit your dentist several times each year for hygiene and maintenance. As with regular dentures and other tooth replacements, your implants and their associated components are subject to wear and tear and eventually will need repair, including clip replacement, relines, screw tightening, and other adjustments.
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Will one Doctor do the entire Implant procedure?Usually, a dental surgeon places the implant(s) and performs other necessary surgical procedures – your general dentist provides the temporary and permanent replacement teeth. Both doctors are involved in planning your dental treatment. Also, depending upon a variety of factors, different dental specialists may help with your dental care.
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How much do Implants cost?Before treatment begins, every effort will be made to give you an accurate estimate of all the expenses involved in placing the implants and making your replacement teeth. In many cases, there is an initial charge for the diagnostic work-up, including study models, x-rays, and the fabrication of a surgical template to ensure the best possible result. In addition you will be charged for the abutment or support post(s), plus the crown, dentures, or anything else that will be placed over the implants, including temporary restorations. Periodic maintenance such as hygiene visits, tissue conditioners, denture relines and other repairs will also incur additional charges. When different doctors are involved in your treatment, you will be charged separately for their services. We will try to assist you in estimating what your actual payments will be after we evaluate your insurance coverage or other third party payments. Also, you should consider your personal financial investment in each treatment option as some insurance companies provide limited or no coverage. Each patient is unique, and it is not possible for us to discuss every option and every contingency for treatment outcome. This booklet is intended to help you understand the general treatment options available to you. If your specific treatment options are not clear, please contact us. We will be happy to answer any questions you have about your dental care.
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Why select Dental Implants over more traditional types of restorations?There are several reasons: A dental bridge can sacrifice the structure of surrounding good teeth to bridge the space of the missing tooth/teeth. In addition, removing a denture or a “partial” at night may be inconvenient, not to mention dentures that slip can be uncomfortable and rather embarrassing.