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View from the Chairside: How to deal with dental complications of C-PAP Devices?

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By Dr. Janet Leith

 

Janet's picture

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.

cpap decay

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.

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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.

 

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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.

 

3 Comments

  1. rmkellen@rogers.com September 13, 2013

    There are other direct factors.
    Distillend water is RECOMMENDED, not required. If you use tap water, there is a residue of calcilfic minerals, but when cleaning the container with 1/3 vinegar and 2/3 water, that is removed. I use tap water for better bacterial control. & less bother with purchasing distilled, etc.

    Reply
    1. rmkellen@rogers.com September 13, 2013

      Second, the oral dryness is OFTEN because of mouth breathing even when there is moissturizing in place. Either use a chin strap and/or go to full face mask. MANY patients start with nose unit, then develop mouth breathing from a cold or allergies or ? and do NOT go back to nose breathing. Thus they LOSE the benefit of the cpap. MUST be on alert to catch this.

      Re your problem patient, the oral appliance may increase the caries, harm the mucosa, create thrush, etc. MUCH better to switch to a full face mask to solve his problem.

      I have taken several courses on apnea, treatment. Have made about a dozen intraoral appliances. Wore one myself till had to switch to cPAP then from nose to full face, then plus chin strap because my jaw relaxed to the point that the lower lip was just at or below the bottom edge of the full face mask, thus huge leakage (& noise). My “obstructions” moved from upper airway to INCLUDE lower pharyngeal areas.

      Compliance is critical, and within the patient’s control (and attitude). The dentist can only educate and motivate, and/or make an EFFECTIVE MAD. I strongly Rx that you do NOT let the lab design, or set the protrusive for you. This MUST be done by you in-office, and send an accurate “in-protrusive” bite at the correct protrusive etc, for the lab to COPY. (The labs all offer to set it FOR YOU, on their “machine” but they do not see or assess the patient as to how much protrusive is needed, and what the occlusion is in that correct position).

      This is NOT a procedure that you take U & L impressions and a “bite” and send it to the lab to do the rest. NEED to take at least one PROPER course and get the proper instruments to determine the correct bite, etc.

      There is the option of intraoral appliance if cPAP will not be used.
      This is better than none. But, intra oral MAD will work ONLY with upper airway obstructions. NOT with lower pharyngeal obstruction. (MUST use cPAP or take on the major risks of nil)

  2. David firestone dds December 23, 2017

    I have had a patient for 40 years who has had beautiful gold onlays and inlays undisturbed and meticulously taken care of. She came in regularly for dental checkups, X-rays, and a crown every once in a while. Within one year of wearing a CPAP, I noticed three or four huge cavities inter-proximally. I AM CONCERNED for her and other patients. She’s in her late 70s w normal salivary flow for her age.

    Reply

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