Dental device helps some sleep apnea patients unplug CPAP

Posted: December 10, 2012

The Winchester Star

Dr. Thomas Gromling, who has a dental practice in Stephens City, holds a mouth device that helps patients with sleep apnea. The device pushes the lower jaw forward, which keeps the back of the throat open. (Photo by Scott Mason/The Winchester Star)

Winchester — Every time he snored, Clarence Turner’s wife would elbow him in the ribs.

Tired of the nightly assault, Turner sought medical help in 2005 and was diagnosed with sleep apnea, a condition in which sleep is interrupted because breathing stops.

Turner first tried a continuous positive airway pressure (CPAP) machine, the gold standard for treating sleep apnea.

The CPAP mask blows air into the airway through a hose inserted into the mouth.

But Turner found that the CPAP wasn’t a good choice for him.

“You just can’t get comfortable with a hose strapped to your face,” said the 47-year-old Turner, who lives in Edinburg and works full-time with the Air National Guard.

He couldn’t sleep on his stomach, and the machine was too bulky to pack when he was sent on military assignments.

A co-worker said his dentist had fitted him with a device that let him get rid of his CPAP machine. Maybe Turner’s dentist could do the same for him.

Now, Turner sleeps comfortably with a dental device custom fit for his mouth.

Made of hard plastic, the device moves his lower jaw forward while he sleeps, which keeps the back of his throat open.

He’s enjoying a good night’s sleep and doesn’t miss his wife’s elbow jabs.

“Once I go to sleep, I’m pretty much out,” Turner said.

What is sleep apnea?

Snoring can be annoying, funny or embarrassing — depending if you’re on the giving or receiving end of the noise.

It can also be a sign that something is seriously wrong.

Sleep apnea is caused by an obstruction in the upper airway. Extra tissue may block the back of the throat or the airway may close because of a lack of muscle tone.

An estimated 18 million people suffer from sleep apnea, according to the National Sleep Foundation.

Sleep apnea deprives the body of oxygen and causes it to retain the carbon dioxide it would normally exhale.

Left untreated, sleep apnea increases the risk for high blood pressure, heart disease and stroke.

Extreme fatigue from a lack of sleep may contribute to accidents, depression and a decreased quality of life.

It can harm relationships if partners must sleep in separate rooms because of constant snoring.

Dental devices

Dental devices are becoming a popular method of treatment, said Winchester pulmonologist Dr. Jeffrey S. Lessar, medical director of Winchester Medical Center’s Sleep Lab.

“As a sleep doctor, I’ve written many prescriptions for these devices,” he said.

When Lessar arrived in Winchester seven years ago, no dentists offered the service. Now, a couple of dentists in the area do. Lessar said he doesn’t hesitate to recommend a patient try a dental device if they don’t like the CPAP.

“A lot of people just don’t like the CPAP, which is somewhat understandable,” he said. “It’s a great asset to have a couple of different treatment options.”

The dental devices gradually move the lower jaw forward a couple of millimeters over a period of time.

“This is something that is fitted for you,” Lessar said. “It takes a lot of skill.”

Dental devices are excellent options for people with mild to moderate sleep apnea, he said.

“In severe cases we start to see less impressive results,” he said. Severe apnea occurs when breathing stops more than 15 times per hour.

Those with severe cases really need the CPAP machine, he said.

On the front lines

Dentists are good front-line warriors in the fight against sleep apnea, Lessar said.

They can often see if excess tissue is blocking the airway. Teeth grinding may be another indication that the person is struggling for breath.

Dr. Thomas Gromling, who practices in Stephens City, became interested in treating sleep apnea about a year ago after several patients told him they had been recently diagnosed. He is Turner’s dentist.

Gromling attended two advanced training seminars to learn how to treat sleep apnea.

He works closely with local physicians to make sure the patient is properly diagnosed and that the device works properly.

The dental devices, custom fit for each person’s mouth, cost from $2,000 to $6,000.

Medical insurance will cover the devices if the patient has been diagnosed with sleep apnea by a medical doctor and has tried to use a CPAP machine, Gromling said.

Wearing the mouth guard can alter a patient’s bite, Gromling said. Patients must chew gum or eat something that requires vigorous chewing each morning to get their jaw back in alignment.

Dentists are often reluctant to mess with a patient’s bite, but the trade-off can be worth it, he said.

“We really have to think out of the box and go out of our comfort level,” said Gromling, who has had a dental practice in Stephens City for 32 years. “We can save lives.”

And marriages.

— Contact Robyn Fontes Taylor at rtaylor@winchesterstar.com