THE MANAGEMENT OF SNORING

Murdock Laboratory has taken the lead in appliances for the management of snoring. Currently only about two percent of practitioners treat this condition. When it is taken into account that one in every three adults snore and that snoring is now acknowledged as a warning sign that normal breathing is not taking place during sleep, the potential market for this treatment is obvious.

For the majority of adults, snoring does not involve a serious medical disorder. However, it can be the first warning sign of obstructive sleep apnea (OSA). If OSA is suspected the patient should be referred for a sleep study to make the determination if OSA exists. If OSA is the cause of the snoring, the repositioning appliances are of little value and may actually prevent the patient from seeking needed medical treatment.

Most people who snore do so while sleeping on their back. During sleep the muscles of the face relax and there is a tendency for the mandible to open and drop back and mouth breathing takes place. When mandibular retrusion is combined with a lax muscle posture, the tongue has a tendency to sag and further obstruct the airway. When compounded with the large volume of air introduced by mouth breathing, the result is snoring. Dental appliance therapy has demonstrated about a seventy percent chance of reducing or eliminating the snoring activity.

There are other conditions that can lead to snoring. Heavy smokers, people who are overweight, or consume large quantities of alcohol before retiring tend to snore in all sleeping positions. Some of these conditions cannot be addressed with appliance therapy alone.

The mandibular repositioning appliance (MRA) has been a standard for the treatment of snoring, hypopnea, and mild sleep apnea. The Murdock Laboratory ASA is a minimal appliance. It allows maximum room for the tongue while effectively repositioning the mandible. The only drawback is that it lacks adjustability. If the mandible requires additional advancement, a new construction bite is needed and the appliance is returned to the laboratory to be reset to the new bite relationship. There is a modest fee to reset the appliance.

The adjustable ASA is the smallest, lightest adjustable repositioning MRA available. The simplified repositioning screws also act as a hinge to permit a range of movement of the mandible, without an excess of lateral movement. If it is necessary to posture the mandible more forward, simply open the adjustment screws equally on each side.

Requirements for an MRA are: upper and lower casts and a bite registration taken in an end to end relationship with about four millimeters between the incisors. This is close to an ideal starting point for this type of appliance.

The Nor-Snor was designed by Dr. Darick Nordstrom. The appliance has undergone extensive trials at Stanford University sleep clinic and has been shown to be successful in a wide range of studies.

The Nor-Snor allows maximum space for the tongue. The elements are highly retentive and the appliance is constructed on the Accu-Liner articulator. Patients report a high level of comfort due to the repositioning rakes allowing a broad range of mandibular motion while preventing the mandible from dropping back during sleep. A truly innovative design.