Hello everybody. Dr. Ko here. Thank you for visiting our website. I would like to take the next couple of minutes to go over with you very quickly the workflow of treating, breathing, and sleep for adults in our office. Most people come to us because they have a previous diagnosis or they’re suspecting that they had sleep apnea. Now we don’t like to take their words for it, so we typically would put people through a test. This is a type three take home device called sleep image. And you wear this little ring that’s paired to your phone and the data really gets uploaded onto the cloud. So with this data and with imaging, we would customize a treatment for you. What we do a lot in our office is creating space. It’s expansion. A lot of people who drive from very far to come to see us because we’re really known for expanding the space for the palette and for the tongue. There are times we don’t use that tool. There are times when we reposition the mandible forward and in doing so the tongue goes forward with it. So that actually helps with people who have sleep apnea. So Mandibular advanced device is one tool we use. We don’t use this a lot. Our office is more known for expansion, but this is a tool that we do have. Now, other tools we have is, along with Invisalign and also a device called Vivos, DNA, we’re able to actually influence the shape of the palate and also change the circumference where the teeth land. And you can kind of see this is one of the patients we treated who had moderate sleep apnea after expansion with Vivos and Invisalign. Now the teeth has room to fit in without crowding and the shape of the palate is different as a result. Sleep apnea now has went from mild to none. Another tool we would use is called Mar P. The full acronym is Mini Implant Assisted Rapid Pal Expander. So same thing. This is really about creating more space for the tongue. And then typically when we create more space for the tongue to function in, we work with local myofunctional therapists to train the tongue to function that bigger space. And then afterwards we will release the tongue with our CO2 laser. All the workflow really is done in office.
We have many, many years of experience and patients do come from all over the place to come to see us for this kind of treatment. So I hope this video is helpful. If you have any questions, please do call the office and we’ll be happy to actually talk to you and customize the treatment for you.
In our office, we treat sleep disorders seriously. Even though not all sleep disorders are related to the head and neck anatomy, the most common disorders such as obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) have a lot of mouth anatomy connections. In our office, we perform home sleep test (HST) using SleepImage device. We work with local and remote sleep physicians to provide a solution for patients who are diagnosed with OSA and cannot tolerate CPAP. This is a sample SleepImage study for a SevereOSA Adult.
Different treatment options are available in our office:
Invisalign Expansion – Not all Invisalign treatment is expansive in nature. Because airway is paramount, so the goals of Invisalign treatment in our office is never retractive, always expansive. Expansive movement allows more room for the tongue which often contribute to the obstruction. Sample of Invisalign expansion below.
Sleep Apnea & TMJ
I’d just like to take the next few moments to quickly run through a few slides to show you what we do for adults with sleep apnea. There are many ways to treat adults with sleep apnea, CPA being the gold standard, and I would never deviate from that if the patient want to entertain the idea of wearing CPAP at night. A lot of times in our office what we try to serve is patients who really cannot tolerate CPAP, doesn’t want to wear a mandibular advanced device. And then we’re talking about different alternatives to help our patients. This particular patient actually came to me because he has team to issues in knowing the studies. We know that people who have TMJ issues also tend to have sleep issues. So in doing a sleep study, we found out that he has moderate sleep apnea, 3% drop in oxygen obstruction, 13 times an hour, respiratory disturbance 28 times an hour after treatment, you can probably see that his tongue fits nicely into the space.
We expanded him with different methods and afterwards what we saw was his obstruction now went down from 30 to five, and then his respiratory disturbance went from twenties down to eight. So in treating his TMJ by creating more room for his lower jaw, the tongue now actually functions in more forward position, which in turn helped with his sleep. And interestingly, what happens is when people sleep better, their joints gets better. So this is hopefully a helpful video for you if you want to entertain the idea of seeking help with TMJ or sleep. Thank you very much for watching and if you have any questions, please feel free to reach out. Thank you.
Expansion-Dr-alan-ko
Vivos DNA appliance – Epigenetics Orthodontic Therapy (EOT)
Patient doubled the size of her airway (from A-P) dimension, post treatment on the right
Increase in the overall size of the airway (smallest cross section) at the completion of Vivos treatment, post treatment on the right
This new and advanced oral appliance is:
- None surgical
- Removable
- Only worn in the evenings and night time
- Shown to reduce or eliminate sleep/airway problems
- Shown to improve migraine headaches and TMJ symptoms
- Improve nasal breathing
- Reduce or improve snoring
- Increase energy
- Improve posture
- Decrease anxiety
Oral Appliance Therapy (AOT)
Mandibular Advancing Device (MAD) also works. The goal is to move the tongue and other lower jaw anatomy out of the airway. We predominantly use Prosomnus, one of the leading companies for appliance therapy.
We can also make referrals to oral surgeons, periodontists, and orthodontists for other possible treatment options:
Maxillary mandibular advancement (MMA) – surgical intervention to advance the airway. We will refer you to world renowned oral surgeon in Boston.
Maxillary Mandibular Advancement Surgery
Distraction Osteogenesis Maxillary Expansion (DOME)
Mini-implant assisted Rapid Maxillary Expansion (MARPE)
Sleep Disorders FAQ
What are sleep disorders, and how do they affect my health?
Sleep disorders like sleep apnea, snoring, and insomnia can significantly affect your overall health. Sleep apnea, for example, leads to interrupted breathing during sleep, causing poor oxygen flow. This condition can result in excessive daytime fatigue and increase the risk of heart disease, high blood pressure, and stroke. Addressing sleep disorders is essential for improving sleep quality and overall well-being.
What types of dental appliances are used to help with sleep disorders?
One type of the dental appliances we use to treat sleep apnea, is called mandibular advancement device (MAD). They are designed to treat sleep disorders by gently repositioning the lower jaw and tongue to keep the airway open during sleep, reducing the likelihood of airway obstruction and helping to improve sleep quality and overall health. We also use epigenetic expansion devices (for adults), to permanently change the position of teeth and stretch and remodel palatal bone to create better airflow. Please refer to www.vivos.com for more information. For selective cases, we will also use mini-implant assisted rapid palatal expansion (MARPE) to expand the maxilla. This is by far our most effective tool to create nasal airflow and increase the 3D volume for the tongue. The majority of sleep apnea really is a space issue, and by creating space for the tongue, sleep apnea can be improved.
What’s your favorite dental appliances to use to help with sleep disorders?
That depends on if we are treating adults or kids. Kids as young as 11 years old, we will want to make a permanent change in the anatomy by expanding the upper jaw and stimulate lower jaw’s forward growth whenever possible. We know with the face and jaw growing forward, it prevents (or decrease the chance of) future sleep apnea. For adults, our goal is to create more room for the tongue (primary reason for sleep apnea), and to do so – we will use tools that make permanent changes such as Invisalign, Vivos DNA appliance, or MARPE. For more immediate relief, MADs are used. There is a certain patient population who will pick one tool over another due to time, social/work reasons, or finances. We will pick the tool that will fit with your lifestyle.
How long do you have to wear Vivos/DNA?
The commitment of wear usually is 14-16 hours or more. I usually ask patients to wear the appliance from 4-5pm in the evening and remove it when they get up in the morning at 6-8am. The beauty of this device is, you can take it out whenever you need to eat, drink, or brush/floss your teeth.
How long is the treatment for Vivos/DNA?
Please expect 18 months to 24 months of treatment. The treatment is often done in combination with either orthodontics or Invisalign.
Is there any pain with Vivos/DNA appliance?
No, there should not be any pain with Vivos/DNA appliances when used appropriately. The device is very technique sensitive and will require constant monitoring with our office to be successful.
What happens after I complete the Vivos/DNA appliance?
I like to say treating airway issues is like climbing a mountain or running on a hill. Every little treatment you do will help you get closer to the top of the hill. Making more room for your tongue is just the beginning. It will help but will not solve the problem completely. Doing myofunctional therapy (physical therapy for the tongue and oral muscles) will also get you even closer but still won’t get you to your destination. Typical treatment after Vivos/DNA will involve Invisalign, myofunctional therapy, tongue tie release (frenectomy), and even for some severe cases, MAD is used to get to our final destination.
What types of sleep disorders can be treated with mandibular advancing devices (MADs)?
MADs are effective for treating obstructive sleep apnea (OSA) and chronic snoring. When the throat muscles relax excessively while you sleep, it might obstruct your airway. By repositioning the jaw and tongue, dental appliances keep the airway open. They also benefit individuals with mild to moderate sleep apnea or those who can’t tolerate CPAP machines. Even though there is no age requirement for each device, we typically like to make long term changes for younger folks – using the tools such as MARPE or Invisalign.
How do I know if I need a dental appliance (mandibular advancing devices) for sleep apnea or snoring?
If you experience loud snoring, choking, or gasping during sleep, excessive daytime drowsiness, or difficulty concentrating, you may have a sleep disorder treatable with a dental appliance. A thorough evaluation by your dentist or sleep specialist is necessary to determine whether an appliance is right for you. Our office will offer a Type III take home sleep test to assess the severity of your condition and titrate the amount of advancement based on daily sleep study to determine the optimal advancement.
Are mandibular advancing devices (MADs) comfortable to wear during sleep?
Most patients find dental appliances comfortable once they become accustomed to wearing them. These devices are custom-made to fit your mouth, ensuring a snug and comfortable fit. While there may be an adjustment period, many patients report improved sleep quality and reduced symptoms within the first few weeks of use. Your dentist will ensure a proper fit and adjust to enhance comfort and effectiveness.
How long does it take for MADs to work?
The effectiveness of MADs depends on the severity of your sleep disorder and how your body responds to the device. Many patients notice an improvement in sleep quality and a reduction in snoring within the first few nights. It may take a few weeks to a few months for optimal results in treating sleep apnea to experience significant changes. We will titrate the amount of advancement with exact data by having our patients test with a Type III sleep study device while we test different degrees of advancement of the mandible.
Are dental appliances such as MADs safe, and will they damage my teeth?
MADs are safe when properly fitted and monitored by a qualified dentist. They gently reposition your jaw without harming your teeth or gums. However, like any medical device, regular follow-up visits are necessary to ensure there are no adverse effects. We will also fabricate a morning after appliance to wear to reset the jaw back to where it used to be. We will adjust the appliance as needed to ensure it functions correctly and comfortably, making dental appliances a safe and effective treatment for sleep disorders.
How do you determine if Invisalign expansion, Vivos/DNA expansion, or MARPE expansion is right for me?
We try to factor in age, gender, treatment goals, signs, symptoms, and objective measurements to determine the right tool. There are also other non-concrete factors such as social, work, financial that we take into consideration also.
How long will MARPE take?
Factoring in MARPE design, placement, and Invisalign/orthodontics, the treatment time usually ranges from 12 months to 24 months.
For more information, please visit VIVOS website or call our office at (508) 850-0686 for a consultation.
