Dental Sleep Medicine Insider November DSM Insider | Page 5

JOHN TUCKER, DMD
TREATING THE PAP INTOLERANT EDENTULOUS
PATIENT WITH ORAL APPLIANCE THERAPY
O
bstructive sleep apnea
(OSA) is a disorder charac-
terized by repetitive collapse
of the upper airway during
sleep, with consequences of
nocturnal hypoxemia and re-
current arousals from sleep. 1
The prevalence of OSA is sig-
nificant and increasing with
greater obesity and aging of
populations. 2 In addition to
decreased neurocognitive
performance from recurrent
nocturnal arousals, there ex-
ists an increased risk of fatal
and nonfatal cardiovascular
events as well as all-cause
mortality in patients with se-
vere OSA. 3,4 Recent evidence
has demonstrated that the
risk of cancer mortality and
ischemic stroke carry a dose-
response association with the
severity of sleep-disordered
breathing (SDB). 5
The United States population
of adults 65 years of age and
older is to increase from 13.5
million in 1991 to 21.8 million
by 2020 yielding a relative
increase of 61%. 6 Depending
on the definition used for AHI,
62% to 81% of this population
will suffer from OSA. 7 Ende-
shaw et al reported that the
risk of OSA might increase as
a result of edentulism. 8 Full
mouth extraction manifests
a worsening of the cardiore-
spiratory symptoms, approx-
imately doubling the number
of episodes of apnea-hypo-
pnea per hour in a patient
with OSA. 9 Edentulism leads
to a decrease in the size and
tone of the pharyngeal mus-
culature, which is a crucial
risk factor for OSA. 10 A loss in
vertical dimension of occlu-
sion leads to a reduction of
the lower face height, count-
er-clockwise rotation of the
mandible and may lead to
OSA. 10
Almeida et al commented,
“There is no consensus in the
literature about the impact
of complete denture wear on
OSA.” 11 “Contrary to previous
studies, we found that OSA
patients may experience more
apneic events if they sleep
with their dentures in place.
Specifically, in mild OSAS
patients, the use of dentures
substantially increases the AHI
especially when in the supine
position.” 11
Bone resorption in edentu-
lous alveolar processes has
been studied extensively. It is
a chronic, progressive and ir-
reversible process that occurs
in all patients. 12 In complete
denture wearers there is a
greater degree of mandibular
resorption than maxillary re-
sorption. Atwood and Tallgren
documented that mandibular
bone loss is four times great-
er than maxillary bone loss.
Irreversible loss of supporting
bone structure results in the
most common patient com-
plaint, difficulties with reten-
tion and stability of mandibu-
lar dentures. 13,14