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Welcome to the practice of maxillofacial prosthodontist and cosmetic dentistry specialist Michael Cortese

Princeton

Prosthodontics

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Sleep Apnea & Other Services

Do you or your spouse snore loudly and repeatedly, preventing one of you from getting a good night’s rest? Snoring may be harmless — or, it may be an indicator of a serious sleep disorder known as obstructive sleep apnea (OSA). Dr. Cortese works in close collaboration with sleep specialists who diagnose OSA and offer effective treatment options.

It is common for people not to know they have sleep apnea. Most of the people Dr. Cortese screens for tooth grinding (bruxism) are not aware they have sleep apnea until Dr. Cortese points it out and refers them to a certified sleep specialist for diagnosis. Even husbands and wives complain that their spouse snores, but do not realize the underlying cause is actually very serious (i.e., their spouse is not getting the oxygen they need while sleeping, which is what causes sounds like snoring, gasping and choking).

After delivering a custom-made oral prosthesis to the patient, which is fitted and adjusted as needed, we re-test the patient to ensure the appliance is working and he or she is getting the oxygen they need during sleep.

Often, our sleep apnea patients come in for a follow-up visit and say, “Boy, I feel great now! I have more energy and I’m not tired all the time.” One patient told us he did nothing differently and not only felt great but also lost 12 pounds.

Snoring and Obstructive Sleep Apnea (OSA)

OSA is a pattern of breathing cessations during sleep. It occurs when the soft tissues of the palate relax in the back of the throat, preventing the clear flow of air. Snoring is the sound of air vibrating through the blocked airway, and it is usually followed by choking or gasping, as the person partially wakes up and resumes breathing. If you have OSA, you might unknowingly experience hundreds of pauses in breath in one night.

Sleep apnea is a serious health concern because the body’s organs aren’t receiving the oxygen they need during sleep. Also, the body isn’t getting the restful, restorative sleep it needs. Sleep apnea raises the risk of life-threatening conditions such as heart disease, high blood pressure and stroke. Not getting enough sleep results in excessive daytime sleepiness and other cognitive problems, such as difficulty concentrating and lapses in memory.

Typically, OSA is diagnosed by a sleep specialist after a sleep test has been conducted. After a diagnosis has been made, treatment options are evaluated.

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Figure 1 A mandibular advancement appliance that works well for bruxers

Pediatric Sleep Apnea

Children can be affected by sleep apnea. Signs of pediatric sleep apnea include snoring, poor performance in school, hyperactivity, hostility/anger and breathing through the mouth instead of the nose. Experts have found a link between pediatric sleep apnea and attention deficit disorder and attention deficit hyperactivity disorder. Some children are misdiagnosed with ADHD but the sleep apnea piece is missed. Children that snore loudly and chronically should be evaluated by a sleep specialist for OSA. The American Association of Pediatrics “Practice Parameters” recently stated that all children should be screened for snoring because of the 70 percent overlap of snoring and sleep apnea.

OSA is a medical condition that is diagnosed by a medical doctor, but dentists are on the front line screening for this condition, working with a sleep physician, ear-nose-throat doctor (ENT) and other medical professionals to treat this condition. Adult therapies for the management of OSA are not suitable for children. Therapies such as CPAP and OAT have been known to arrest skeletal development of the growing child. The good news is, with proper diagnosis and communication between dentists and medical specialists, pediatric OSA can be cured.

Continuous Positive Airway Pressure (CPAP)

One of the most popular treatment options for sleep apnea is an apparatus called a continuous positive airway pressure (CPAP) machine. It consists of a mask worn over the nose (and possibly mouth) and delivers a constant stream of pressurized air into the throat. The pressurized air keeps the upper airway open and prevents any pauses or interruptions in breath. Individuals that sleep with a CPAP machine snore less, sleep better and report more energy during the day. Those who cannot tolerate or refuse CPAPs can have specially designed oral devices to open the airway and stop sleep-disordered breathing.

Craniofacial Pain Management

Being an accredited maxillofacial prosthodontist, Dr. Cortese has experience in cranial pain management, which is often a chronic side effect of temporomandibular joint (TMJ) disorder. After evaluating the specific pain and suspected cause, Dr. Cortese can recommend a pain management plan. Possible techniques include behavior/lifestyle modifications, physical therapy, medication, massage, injections and more.

Palatal Obturator/Obturator Prosthesis

An obturator is a prosthetic device that closes the opening created when surgeons remove cancerous tissues or rehabilitate congenital cleft palates. The obturator restores the patient’s ability to speak, swallow and chew.

Maxillofacial Prostheses

A maxillofacial prosthesis is a device designed to replace an area of tissue and/or bone in the jaw or face. The defect may be the result of genetics (i.e., the patient was born with it), disease (e.g., cancer) or a traumatic injury. Facial prostheses for the eyes, ears and noses, replace those removed during cancer surgery and restore patients’ quality of life.

Sleep Apnea FAQs

What are the signs and symptoms of sleep apnea?
The primary symptom of sleep apnea is repeated pauses in breathing while sleeping. This can cause choking or gasping sounds. Loud, frequent snoring is another indicator of sleep apnea. Many people with sleep apnea feel excessively tired and fatigued during the daytime and often have trouble concentrating, feel irritable or experience mood swings.

Is sleep apnea dangerous or life threatening?
Studies show that sleep apnea is linked to a heightened risk of serious, life-threatening conditions such as heart disease, high blood pressure and stroke. People with untreated sleep apnea can also suffer from serious mental health conditions, such as depression or anxiety, due to the chronic lack of quality sleep.

Because of the risks associated with sleep apnea, early detection and intervention is critical.

If my spouse or I snore loudly, do I have sleep apnea?
You may. Not everyone that snores has sleep apnea and not everyone that has sleep apnea snores. However, if the snoring is coupled with another possible sign or symptom, it is worth it to be evaluated by a sleep disorder specialist. A sleep study can help to determine whether you or your partner is suffering from sleep-disordered breathing.

How is sleep apnea treated?
Sleep apnea can be treated a few different ways. The traditional method of treatment involved a bulky CPAP machine to keep the airway open during sleep. Newer treatments use a small removable oral appliance to keep the airway open. Dr. Cortese helps to fit and manage patients that choose to use an oral appliance to stop sleep apnea episodes.

Contact Princeton Prosthodontics

If you would like more information about sleep apnea, craniofacial pain management or maxillofacial prosthetics, please schedule a consultation with Dr. Cortese at Princeton Prosthodontics. Contact us today to make an appointment.