In expanding the scope of his practice to include treatment of obstructive sleep apnea with oral appliances, Mark Katz, DDS, MSD, has set out to improve the lives of his patients and community by providing an orthodontic alternative to CPAP and surgery, reports Orthodontic Products, a Sleep Review sister magazine.

Katz is quick to point out that there are side effects associated with OAT for sleep apnea; and they are topic number one when he discusses this treatment modality with patients. Tooth movement is one of those side effects, and Katz admits, as an orthodontist, this goes counter to what he’s trained to do. 

“As an orthodontist, it’s a dilemma for me to hand them an appliance that I know is going to change their bite and move their teeth,” he says. “I have to take off my dental hat and put on my medical hat, recognizing, from a medical standpoint, that OAT may be their only choice. For primary snoring, OAT is the most effective treatment. If AHI is less than 30, patients usually have a choice between CPAP and OAT. For patients who are CPAP intolerant or noncompliant, there is no other non-surgical choice that is as effective as OAT. Criteria for surgical intervention are narrow. “Really and truly, from the sleep doc’s standpoint, the oral appliance is the next step.” 

In Katz’s experience, tooth movement and bite change are progressive. Usually changes are minimal. “I discuss possible tooth movement and bite change with all patients every time they come in. I ask them if they’re ok with it and the majority of folks say ‘yes.’ The typical response is, ‘Well, I’m not going to wear CPAP’ or ‘I hated that machine; I love this,’” he says, adding, “A few patients have surprised me with dramatic tooth movement and bite change, but, interestingly, these patients either do not notice it or do not care.” 

Katz adds, “I can sleep at night as long as I know that I’ve explained to them the side effects and let my patients know that I’m going to pay very close attention to the side effects. I have done orthodontic treatment for very few patients to reverse the undesired side effects of OAT.” 

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