Treatment For Denture Patients

Denture patients are especially susceptible to obstructive sleep apnea, because they have no bite platform against which they can prop their lower jawbone to prevent it from dropping down and back and pushing the tongue base into the space needed for airway passage through the pharynx (throat). However, denture patients cannot wear the mandibular advancement appliances that are used to treat obstructive sleep apnea in people with natural teeth, because their gums cannot tolerate the pressure required to push the lower jawbone forward off the upper jawbone. Implants have been used to enable some edentulous people to undergo some mild mandibular advancement, but the pressures can endanger the implants. Therefore, until now, their only options have been CPAP or surgery.

Now denture patients have a non-surgical alternative. Dr. Summer has developed and successfully tested new mechanisms that can be added to denture base plates (dentures without teeth) and worn during sleep to prevent the soft tissues of the throat from plugging the airway. The tongue is held to prevent it from falling back into the pharynx, and the distal end of the soft palate (uvula) is drawn forward to prevent it from contributing to the obstruction and snoring in the nasopharynx. Both devices can be carried on a set of denture base plates (dentures without teeth), where they work together to open the airway. The denture base plates are not used for chewing and are constantly cushioned by the tongue, so they require very little retention. They can even be used during sleep by some people who can’t wear dentures during the day. The soft palate elevator has already been FDA approved. The tongue holding device was found safe and effective in patients with natural teeth in a clinical study for the FDA, but not yet in denture patients. Therefore, we are conducting a clinical study involving denture patients with untreated obstructive sleep apnea. We do not want to remove anyone from a CPAP that they are currently able to use. Denture patients who qualify will receive a tongue holding device along with before and after home sleep testing to evaluate its effectiveness. If the tongue holding is not effective, a soft palate elevator will be added, followed by another home sleep test.  

Tongue holding is especially effective in denture wearers; because the tongue gripping surfaces can extend almost all the way to the cheeks, and the entire tongue body keeps the denture base plates comfortably seated like a giant cushion, so they require very little retention. They can even be effective for treating sleep apnea in people who cannot wear dentures during the day for eating or talking. The tongue holding device holds the tongue body between upper and lower tongue gripping surfaces which each contain thousands of tiny bristles, like tongue velcro, in sheets that are molded to fit your mouth.  The tiny bristles are all slanted forward at a 45 degree angle to prevent the tongue from dropping back into the pharynx. 

                                      UPPER TONGUE GRIPPING SURFACE ON DENTURE BASE PLATE

The photos above show an upper tongue gripping surface mounted on an upper denture base plate. As seen in the right side photo above, the upper tongue gripping surface is spring mounted to prevent its grip from becoming interrupted when the mouth opens part way or makes other submaximal movements, like in bruxism. As the mouth opens, the spring pushes lightly down on the upper tongue gripping surface to keep it in contact with the surface of the tongue, as shown from left to right below.

                                  GRIP IS MAINTAINED BY SPRING DURING PARTIAL OPENING

 The upper tongue gripping surface is split into two segments that move independently to ensure that swallowing is comfortable. The two segments are connected by lightweight torsion springs as shown below left, then attached to the upper denture base plate by means of a length of stainless steel tubing passing through the coils, shown below right. 

  

                                                      SEGMENTED UPPER TONGUE GRIPPING SURFACE

During the first part of the swallow, the tongue first pushes up in front, compressing the anterior spring. Then in the second part of the swallow, the tongue base pushes up forcefully, accomodated by the movement of the posterior half of the upper tongue gripping surface, as shown below right.

 

                         UPPER TONGUE GRIPPING SURFACE SPLIT TO FACILITATE SWALLOWING

The lower denture base plate can extend buccally far beyond the edentulous ridges, because there are no chewing forces to apply asymmetrical forces that would tip the denture base plate to one side or the other.  In the photos of a lower denture base plate below, the narrow flat occlusal table, which supports the lower tongue gripping surface, extends a few mm beyond the edentulous ridge on both sides. 

 

The lower tongue gripping surface is dipped in boiling water and shaped to fit the lower denture base plate. 

   

                                         LOWER TONGUE GRIPPING SURFACE ON DENTURE BASE PLATE

The goal of the tongue holding treatment in denture wearers is not advancement, which would apply pressure to the gums. The goal of treatment is just to hold the tongue up against the upper denture base plate to prevent it from dropping back into the pharynx. To create the cushioned grip that ensures comfort and prevents tongue release during submaximal opening, the lower tongue gripping surface, (rather than the upper tongue gripping surface in dentate patients), is spring-loaded - mounted on the lower denture base plate by a pair of thin wire springs that push it continuously upward into the underside of the tongue.Preferably, the lower tongue gripping surface is "spring mounted" on the lower denture base plate, as shown below. The lightweight wire produces a gentle bias upward on the back of the tongue.

 

 

  

                                                          LOWER TONGUE GRIPPING SURFACE SPRING LOADED

The tongue is gripped between upper and lower tongue gripping surfaces as shown from front and back below.

  

                                           FRONT VIEW                                               REAR VIEW

                                                                             

If tongue holding is insufficient to eliminate the obstructive sleep apnea in a denture wearer, a soft palate elevator is attached to the back of the upper denture base plate, followed by another home sleep test. The soft palate elevator is described in detail in MULTILEVEL ORAL APPLIANCE TREATMENT in detail under the FOR DOCTORS tab.

    

                                   SOFT PALATE ELEVATOR ADDED TO UPPER DENTURE BASE PLATE

The soft palate elevator and tongue holding device are added separately for the purposes of the study we are now conducting, but clinically they work best together, because the forces they apply balance each other out. The light force pushing up on the soft palate elevator applies the same amount of reciprocal force inferiorly on the back of the upper denture base plate, which is simultaneously pushed upward by the pressure of the tongue. The separation of the soft tissues (the soft palate moving upward and forward while the tongue base is pushed down and back) creates space for airway flow as can be seen in the photo below.