View from the Chairside: How to deal with dental complications of C-PAP Devices?
By Dr. Janet Leith
Dr. Janet S. Leith has practiced general dentistry in Ottawa, ON for 17 years. She is a 1992 graduate of the Faculty of Dentistry at the University of Manitoba. She completed the Continuum at the Pankey Institute, is a founding member of the Ottawa Women Dentists Study Club, a Councillor for the Ontario Dental Association, and Secretary for the Ottawa Dental Society.
In my daily practice, I see trends developing. These can be new patterns of decay, perio issues, restorative issues, etc. If I am smart enough, I take notice, start to research what I am seeing, and try to notice it more in my patients. I often realize I am seeing “new things” develop in dentistry.
This week wasn’t any different as I came across another “new thing”: dental complications from C-PAP machines.
The first case I noted was a few years ago, then I began noticing recurring trends that I would save for future consideration.
C-PAP machines require the use of distilled water to prevent desiccation of the oral tissues. For the wearer, the use of the distilled water can be tedious and requires special attention to cleaning and disinfecting the machine, tubing and mask. Quite often, after a while, the wearer just does not bother anymore, which unfortunately could have the devastating effect of creating an artificial xerostomia.
The below periapical radiograph is of a 55-year old gentleman and shows the decay that developed quickly and aggressively over a 6-month period on tooth 2.6. The patient lost the tooth and an implant was subsequently placed.
Another issue I noticed in partially edentulous patients, is that they can find wearing the mask quite uncomfortable.
This gentleman below has a lone-standing central incisor as well as some posterior teeth and normally wears a partial denture. Due to a moderate caries risk assessment he should not wear his partial denture at night. However, he found that the mask pressed his upper lip around the lone incisor and his lip would become quite sore.
The patient asked if I could make him some kind of appliance or mouth guard that would be more comfortable and which would help to protect his lip. After some thought, a sportsguard concept was agreed upon. My lab waxed in some denture teeth and made a sportsguard, using the suck-down technique on a vaccu-former. We could have filled the empty anterior spaces in the final appliance, but chose not to do so to keep the weight of the guard down. The guard is flexible and fairly lightweight. If we find that he collects saliva in the edentulous areas, we can fill them in with clear bite registration material and bonding agent. It also has the added benefit of being able to be used as a custom fluoride tray, which the patient has indeed added to his home-care routine. He reported the guard completely resolved his problem and he is now sleeping quite well.
So, what have you noticed with your patients lately? Do you have a group of C-PAP wearers? Have you noticed increased decay, comfort issues that we as dentists can assist with? Other issues? I would enjoy hearing what issues you have encountered and how you have managed them.