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Supporting Your Practice


A few weeks back, we reached out to our dentists with a call for speakers; dentists who would like to try out or enhance their speaking abilities, by presenting a topic of their choice, clinical or professional, on our website CDA Oasis

Dr. Randy Patch, general dentist from BC, responded to the call with a presentation on the management of obstructive sleep apnea by a dentist. He initially presented the topic at the Pacific Dental Conference which attracted the attention of many dentists attending the conference.

We are grateful to Dr. Patch for sharing his expertise on the topic on CDA Oasis and we hope more and more of you, our viewers and colleagues, come forward with your own content to share and present. We always welcome your contributions, feedback, and suggestions. You can get in touch with us through email oasisdiscussions@cda-adc.ca and/or our toll-free number 1-855-716-2747.

Until next time!

Chiraz Guessaier, CDA Oasis Manager


  • Obstructive sleep apnea (OSA) is a breathing disorder during sleep that is characterized by intermittent collapse of the airwaycausing incomplete reduction or complete cessation of airflow.
  • Upper airway obstruction during sleep may occur at any area between the nasopharynx and the larynx. The etiology could be related to physiologic or anatomical factors. 
  • Several adverse outcomes could be associated with OSA, including motor vehicle accidents, depression unnecessary daytime sleeping, and metabolic and cardiovascular disturbances.
  • The diagnosis involves medical historythorough sleeping history, clinical examination, and objective testing.
  • Treatment modalities for OSA include surgical and nonsurgical approaches. Surgical protocols include tracheostomy (the most commonly used surgery for OSA in the past), nasal surgery, tonsillectomymandibular osteotomy, genioglossus advancement with hyoid myotomy, and maxillomandibular advancement osteotomy
  • The nonsurgical protocols consist of behavioral management, continuous positive airway pressure (CPAP) therapy, and oral appliances (OAs).

Oasis Moment – Take-Away Message (2.55″)

OSA is more prevalent than diabetes in middle to elderly aged folks, with the same dire health risks for an early death or severe disability such as a stroke if not adequately treated.

There are only two effective and acceptable treatments for this common, severe disability, C-Pap or Mandibular Repositioning Appliances (MRAs). MRAs are far more tolerated (90% plus) vs. C-Pap (at best 29% and worst 83% failure rates for compliance) and that only qualified licensed dental practitioners are able and mandated to fabricate and follow-up these appliances. 

Therefore, as a profession, dentistry must get more involved with their physician colleagues in diagnosing and treating this life threatening ‘epidemic! The lives of the eighty or seventy or even sixty per-cent OSA patients who have been fitted with and are being persuaded to buy Continuous Air Pressure machines but do not end up using them effectively over time are still at serious risk.  Our profession and individual practitioners really have a golden opportunity to make a tremendous contribution to treat this serious health issue.


Full Presentation (17.03″)



  1. Mark Antosz June 26, 2018

    Pediatric SDB/OSA is at least as critical as OSA in adults – maybe even more so given the long term implications. But it’s not being screened for very well, if at all, and the management is just as questionable. Multi-channel sleep testing is the gold standard, but resources to administer are thin, and saying a child has OSA or not is of questionable relevance when all the data indicate that children who snore are at the same risk as children with true OSA. Nocturnal pulse oximetry has been demonstrated to be useless, creating false negatives and being only truly valid in obese children. The Pediatric Sleep Questionnaire has scientific validity and a good starting point for screening. Management is another question. T&A removal has been demonstrated to be less effective than predicted in a number of studies, and some point to expansion being more effective. Our own protocols now: routine screening with PSQ; if problematic, palatal expansion (and sometimes maxillary protraction if Class III); re-evaluate; ENT referral if patient response not adequate. Expansion is very easy to do even at 3 years of age. Our barometer: if the child is OK with a prophy/fluoride at the dentist, then expansion is going to be a piece of cake.

  2. Dr. G. Blischak June 26, 2018

    My brother used to work for this company. imtheramedical.com
    They clamp the hypoglossal nerve with a radial clamp and like a pacemaker, they stimulate the hypoglossal nerve to contract the tongue and stay out of the back of the throat. Because other countries in the world have different regulations than the FDA, they have been able to place on many patients in other countries. My understanding is that the results will prove to be very encouraging. This is not first-line therapy and there are some people who are just too fat for OSA treatments, but my understanding is that this works very well. Certainly less invasive than mandibular surgery, if it is ever offered to North Americans, but it is likely a long time away from the marketplace.

  3. James B June 27, 2018

    It is interesting that you have not once mentioned Maxillo-mandibular advancement (MMA) for the correction of moderate to severe OSA. It would certainly benefit the members and the dental/medical community to not only educate people about this well tolerated, predictable treatment option for those that are higher than mild OSA (which is the only form known to be treated prdictably by an oral appliance according to the literature).

    As it stands, the only ones able to provide MMA treatment are your OMS colleagues- but it benefits patients immensely if there general dentist knows about the option. Please look at Dr. Reginald Goodday’s literature. There are many well done studies that should be discussed if the topic is OSA.


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