Seattle Protocol Archives - Eggert Family Dentistry Blog

Seattle Protocol Therapy – Molly’s Story

By: Dr. Elizabeth Eggert

How did this start?

Molly came to us with questions during her recare appointment. She had recently had a sleep study done with her doctor and had been diagnosed with Mild Sleep Apnea. She was given a CPAP (Continuous Positive Airway Pressure) machine to try, but wanted to know her other options as the CPAP wasn’t working out that well for her. CPAP therapy is the “gold standard” treatment for sleep apnea, but due to the high air pressure needed to prevent the collapse of the airway, some patients find that they just can’t tolerate the therapy. Molly knew about the Seattle Protocol from our blog articles and wanted to know more.

Molly suffered from acid reflux and had severe demineralization and decay with her teeth. She told us she never really slept well and had been taking Ambien for 15 years to help with her sleep issues. Despite the medication, she still found that most afternoons or evenings she needed a nap to help combat her excessive fatigue.

What did Molly want?

Molly wanted to sleep better. She didn’t want to be so fatigued. And, she wanted something more comfortable than the CPAP option for her sleep issues. We talked to Molly about the possibility to undergo the Seattle Protocol to see if using a nighttime appliance could help her sleep better. The Seattle Protocol is a six-step process that runs patients through different types of appliance options to see what is the most non-invasive appliance/splint to improve sleep. Typically at one of the six stages, patients will feel better and the symptoms they have from sleep-disordered breathing or sleep apnea will improve significantly. With the Seattle Protocol, each step builds upon the last, but patients don’t necessarily need to complete the entire process as the purpose of the protocol is to determine the phase that provides the best relief of symptoms.

What was involved?

We did a comprehensive evaluation of Molly’s bite and function to be sure that having her wear a nighttime appliance wouldn’t trigger any joint, muscle, or teeth issues for her. Then, we started Molly with the first phase of the Protocol – Nose Clearing and Mouth Taping. The purpose of mouth taping is to keep your body breathing through your nose, which is the most healthy way to breathe. Mouth taping should only be done under a doctor or dentist supervision, however. Molly did well with the mouth taping and then we worked her through the Protocol using the myTap appliance. The different stages of the Protocol involve different parts of myTap.

Moving through the stages of the Protocol, Molly reported that she was sleeping better and napping less. She found the Stage 3 version of the myTap appliance to be the most effective for her. In this stage, the patient wears a lower arch appliance that holds them in a more forward position.

Molly tried stages 4 and 5 as well, but really felt the most comfortable and the most rested in the Stage 3 appliance so we took impressions of her mouth and had a Mandibular Pull Forward appliance fabricated to custom fit her mouth.

What does Molly think now?

Molly loves her nighttime appliance. She has been wearing it nearly 3 years now and doesn’t want to go back! She reports, “It has just made such a huge difference in being able to function in everyday life. I used to have to take an hour nap every day, but don’t have to anymore.” Molly has had no issues with her teeth or bite changing, as this can be a real side-effect of traditional sleep apnea appliances. She finds her appliance very comfortable.

Molly notes that it might be easy to perceive the Seattle Protocol as being a “great inconvenience,” but she wants to assure people that “IT JUST IS NOT!” Getting used to mouth taping and having an appliance in her mouth were something new, but Molly is so glad she did it because “I couldn’t tolerate the CPAP and my appliance is just SO much better!”

She was very happy to work with Dr. Elizabeth Eggert and liked the attention she paid to having a shared goal. If you have sleep issues, Molly would recommend you have a conversation with the team at Eggert Family Dentistry.

“The entire team is amazing!”

How Mandibular Advancement Appliances Can Improve Oral Health

By: Dr. Elizabeth Eggert

When you’re diagnosed with obstructive sleep apnea (OSA), your doctor may first prescribe CPAP therapy — you know, the face or nose mask attached to a machine that you have to wear at night. However, while CPAP therapy is extremely effective, many people can’t tolerate sleeping with it on every single night.

That’s why oral sleep appliances -– also known as mandibular advancement appliances — are also used to treat sleep apnea. In fact, they have an 80% compliance rate over the CPAP’s 40%.

We fit mandibular advancement appliances at Eggert Family Dentistry and have been able to help many people with OSA improve their sleep, oral health, and overall quality of life.

What is a Mandibular Advancement Appliance?

A mandibular advancement appliance (MAA) is a device that can be custom-fitted to a person’s mouth, and works by temporarily moving the jaw and tongue forward. This adjustment reduces throat constriction and opens up the airways, effectively preventing snoring and sleep apnea.

Benefits of Using a Mandibular Advancement Appliance

You probably already know that sleep apnea causes a myriad of health issues, most notably cardiovascular problems. But did you know that your sleep apnea also wreaks havoc on your dental health? People with sleep apnea also are more likely to experience TMD, bruxism, and dry mouth. Luckily MAAs can reduce and relieve each of these symptoms.

1. Relief from Tooth Grinding and Clenching

Many people who suffer from sleep-disordered breathing also grind their teeth or clench their jaw during sleep. This can lead to a host of dental problems, including tooth sensitivity, worn-down enamel, and even tooth fractures. MAAs can help alleviate these issues by positioning the lower jaw in a more forward position, which reduces the likelihood of grinding or clenching. The thought is that since the body can breathe better, the jaw doesn’t have to move around, trying to find the best position for air exchange.

2. Reducing Dry Mouth

People with OSA often sleep with their mouth open in an attempt to get more oxygen, which leads to dry mouth. Because saliva plays an important role in reducing the amount of plaque on your teeth, dry mouth can cause or accelerate tooth decay. Using an MAA will open up the airway and improve breathing, which will reduce the need to breathe through the mouth during sleep. This will reduce all dry mouth symptoms and keep tooth decay under better control by maintaining the proper amount of saliva in your mouth.

3. Reducing the Risk of Gum Disease

Gum disease is a common oral health problem that can lead to tooth loss if left untreated. People with sleep-disordered breathing are at an increased risk of developing gum disease, as the reduced oxygen flow to the gums can make them more susceptible to infection. By improving breathing and oxygen flow, MAAs can help reduce the risk of gum disease and promote overall oral health.

4. Improving Overall Sleep Quality and Quality of Life

Finally, the most important benefit of using an MAA is improved sleep quality, which can have a positive impact on your quality of life in general. Poor sleep quality has been linked to a range of health problems, and by improving breathing and reducing sleep disturbances, MAAs can help promote your overall health and wellbeing.

Want Better Sleep, Healthier Teeth, and a Higher Quality of Life?

If you have sleep apnea and would like to be fitted for a mandibular advancement appliance, Dr. Jeff Eggert or Dr. Elizabeth Eggert can help! After hearing from your medical doctor and doing an assessment of your bite, we can custom-design your device by taking impressions or digital scans of your mouth. Once the device is ready, we’ll ask you to come into our office for a fitting so we can make sure it’s comfortable and effective. Contact us or call us at 651-482-8412 today to schedule your mandibular advancement device consultation!

Sleep Apnea Treatments: Mandibular Advancement Appliances vs. Traditional CPAP Therapy

By: Dr. Elizabeth Eggert

Obstructive sleep apnea (OSA) is a common sleep disorder that affects 18 million people around the world. It is characterized by pauses in breathing during sleep, which can lead to snoring, daytime sleepiness, and other health problems.

There are several treatment options available for sleep apnea, but two of the most popular are Mandibular Advancement Appliances (MAAs) and Continuous Positive Airway Pressure (CPAP) therapy. While both of these treatments can be effective, they work in different ways and have different benefits.

Let’s explore the differences between MAAs and CPAP therapy and help you determine which treatment option may be best for your individual needs.

Sleep Apnea Treatment Options

First, let’s take a look at all of the treatment options that patients are given when first diagnosed with OSA:

Lifestyle changes: Losing weight, quitting smoking, avoiding alcohol and sedatives, and sleeping on your side may be recommended to improve sleep apnea symptoms.
Oral appliance therapy: This involves wearing a mouthguard-like device (like an MAA) that helps to reposition the tongue and jaw to keep the airway open during sleep.
Continuous Positive Airway Pressure (CPAP) therapy: CPAP therapy involves wearing a mask at night that is attached to a machine. This machine delivers air pressure to keep the airway open during sleep.
Surgery: In some cases, surgery may be recommended to remove excess tissue in the throat or to reposition the jaw.

You and your doctor will be able to review your unique situation to determine which of these solutions is right for you.

While lifestyle changes can treat more mild cases of sleep apnea, they won’t be able to completely relieve symptoms of more severe cases. On the opposite end of the spectrum is surgery: this sleep apnea treatment is usually saved for the most severe cases of OSA.

The middle ground, then, is where Continuous Positive Airway Pressure (CPAP) therapy and Mandibular Advancement Appliances (MAAs) lie. These are the most popular treatment options among people with sleep apnea. While both treatments can be effective treatment options, they work in different ways and have different benefits.

Benefits of CPAP Therapy

Continuous Positive Airway Pressure (CPAP) therapy is:

Highly effective: CPAP therapy is considered the most effective non-surgical treatment option for sleep apnea.
Produces immediate results: CPAP therapy can provide immediate relief from symptoms of sleep apnea, such as snoring and daytime sleepiness.
Can be used for any level of sleep apnea: CPAP therapy can be used to treat all levels of sleep apnea, from mild to severe.
Helps improve overall health: CPAP therapy can help improve blood pressure, reduce the risk of heart disease and stroke, and improve overall quality of life.

However, because of the cumbersome nature of the CPAP machine, many people have a difficult time sticking to it over an extended period of time. It’s also difficult to travel with so many people don’t use their CPAP machine during vacations or trips.

Benefits of Mandibular Advancement Appliances

While CPAP therapy is extremely effective, many people can’t tolerate sleeping with the discomfort of the face or nose mask night after night. That’s where Mandibular Advancement Appliances (MAAs) come in: MAAs have an 80% compliance rate over the CPAP’s 40% compliance rate.

In addition to being easier to stick to as a treatment modality, Mandibular Advancement Appliances are:

Comfortable: MAAs are often more comfortable to wear than CPAP masks, as they are custom-made to fit the patient’s mouth.
Portable: MAAs are small and easy to travel with, making them a convenient treatment option.
Non-invasive: MAAs do not require surgery and can be easily adjusted by Dr. Jeff Eggert or Dr. Elizabeth Eggert.
Effective for mild to moderate sleep apnea: MAAs are often recommended for individuals with mild to moderate sleep apnea who are unable to tolerate CPAP therapy.

Ultimately, the best treatment option for sleep apnea will depend on your specific needs and preferences. Your doctor can help determine the most appropriate treatment option based on the severity of your condition, medical history, and other factors.

Think You Could Benefit from a Mandibular Advancement Appliance?

At Eggert Family Dentistry, we custom-fit mandibular advancement devices for patients with Obstructive Sleep Apnea or other Sleep Related Breathing Disorders. Call us today at 651-482-8412 to schedule a consultation during which Dr. Jeff Eggert or Dr. Elizabeth Eggert can discuss this treatment option with you and answer any questions you may have. Once we’ve decided an MAA is right for you, we can custom-design your device and then calibrate the finished product to make sure it’s comfortable and effective. Contact us to schedule your appointment today!

Treating Sleep-Disordered Breathing: 4 Benefits of the Seattle Protocol

By: Dr. Elizabeth Eggert

Some patients who come to us with chronic dental problems also present airway patency issues. Simply put, airway patency is the ability of a person to breathe, with airflow passing to and from the respiratory system through the oral and nasal passages.

When a person experiences difficulty breathing, especially at night, this can 1) negatively affect one’s oral health, and 2) continue to damage the teeth even after restorative dental procedures have been completed.

So, what does that mean for patients of Eggert Family Dentistry? It means that before beginning any restorative dental treatment, we need to identify and address these airway patency issues using a process called the Seattle Protocol.

The Seattle Protocol

Each of the six steps builds upon the last to open the airway as much as possible, but patients don’t necessarily need to complete the entire process to identify the solution. The purpose of the protocol is to determine which step provides the patient the most relief of symptoms.

Here is a brief description of the six steps of the Seattle Protocol:

Nose Breathing and Mouth Taping: During this stage, you will gently train your body to breathe through your nose, not your mouth.
Temporary Splint for Lower Jaw and Mouth Taping: Once you’ve adjusted to the mouth taping, the second step of the protocol adds a temporary splint for your lower jaw while you sleep.
Temporary Splint for Lower Jaw with Lower Jaw Pulled Forward and Mouth Taping: If adding the lower splint only isn’t giving you the restful sleep you deserve, we add an element that pulls your lower jaw forward.
Temporary Splint for Lower and Upper Jaw with Mouth Taping: If you aren’t getting relief from the previous step, we remove the forward jaw posturing component and add a splint for your upper jaw.
Temporary Splint for Lower and Upper Jaw with Lower Jaw Pulled Forward and Mouth Taping: If you need to continue in the protocol, step five again adds a horizontal component by linking the upper and lower splints together and moving the lower jaw forward.
Temporary Splint for Lower and Upper Jaw with Lower Jaw Progressively Pulled Forward and Mouth Taping: If you still aren’t getting that good night’s sleep, we move to the final stage of the Seattle Protocol. In this stage, we keep moving your lower jaw forward, incrementally, until you feel well-rested.

As we said before, the goal of the Seattle Protocol is to open the airways as much as possible so that your breathing is no longer restricted. You can find a full description of each of the six steps here.

The Benefits of the Seattle Protocol

The main benefit of the Seattle Protocol is to determine a good position to help control your sleep-disordered breathing. However, the Seattle Protocol also comes with a host of other positive benefits for our patients.

Improved safety: The Seattle Protocol prioritizes patient safety by allowing us to take a systematic and collaborative approach to airway management. By following a standardized protocol, Dr. Jeff Eggert or Dr. Elizabeth Eggert can identify and address airway issues quickly and effectively, minimizing the risk of complications during dental procedures. It is also completely reversible so there are no long-term ill-effects.

Increased comfort: The Seattle Protocol takes a gradual and gentle approach to airway management to maximize patient comfort by introducing interventions slowly and adjusting them as needed. More importantly, when the Seattle Protocol is successful, our patients can finally enjoy a comfortable night’s sleep!

Better outcomes: By identifying and addressing airway issues before beginning any dental restorations, the Seattle Protocol ensures that our patients can maintain their new smiles for as long as possible, without any complications. This will not only help our patients recover more quickly but also ensure that they get the most out of their financial investment.

Personalized care: The Seattle Protocol is designed to be flexible and adaptable to the individual needs of each patient. By tailoring interventions to each patient’s unique situation, we can provide the solution that’s right for you.

At Eggert Family Dentistry, the Seattle Protocol assists us in treating our patients with airway patency issues or sleep-disordered breathing. The systematic steps allow us to both address the problem and identify the solution so our patients can receive the best possible care during dental procedures, and achieve the best possible outcomes afterward!

Real Results: Tom’s Story

One of our patients, Tom, came to us with excessive wear, erosion, and many fractured teeth. Tom needed to reconstruct his mouth and we did that in phases, however, during the process we ran into a few complications:

The force of Tom’s bite was so strong that he broke many temporary crowns. Dr. Elizabeth Eggert wanted to get down to the bottom of why Tom’s body would do this because even new crowns wouldn’t survive in such a harsh environment.

Given Tom’s other symptoms, including difficulty breathing through his nose, dry mouth, and the use of a CPAP machine, Dr. Elizabeth Eggert recommended Tom complete the Seattle Protocol to help address his airway patency.

After completing five of the six steps of the Seattle Protocol, Dr. Elizabeth Eggert fabricated a sleep appliance for Tom to continue to improve his airway patency, reduce his bruxism and help him sleep better. After just a month of using his sleep appliance, Tom experienced less clenching, jaw pain, and an overall improvement in his sleep!

Think You Could Benefit from the Seattle Protocol?

If you, too, are experiencing airway patency issues or sleep-disordered breathing, call our office today to schedule a consultation. At Eggert Family Dentistry, Dr. Jeff Eggert or Dr. Elizabeth Eggert will be able to collaborate with you on finding a solution to your unique situation. If you think you could benefit from the Seattle Protocol, contact us or call us at 651-482-8412 for a consultation today!

Teeth Grinding: Long Term Effects and Treatment Options

By: Dr. Elizabeth Eggert

We all have different ways and different places we hold stress in the body. Some of us have a tense neck or tight shoulders or a tender lower back, which can all be stress responses to the ups and downs of this complicated world we live in.

From a dental perspective, there’s one stress response we frequently notice in some patients’ mouths: bruxism.

Bruxism is just a fancy word with Greek origins that means grinding the teeth. (It’s also a pretty good Scrabble word to keep in your back pocket, if you’re into that kind of thing.)

People with bruxism may grind or clench their teeth during waking hours without really noticing it, or they may grind or clench their teeth while they sleep. Either way, many or most bruxers aren’t aware that they grind or clench unless someone else alerts them to the situation, such as a dental professional or a sleeping partner. In fact, some bruxers don’t inflict serious damage on their teeth, and discover their bruxism habit due to TMJ problems, chronic headaches, or by recognizing how tense their jaw muscles tend to be.

However, bruxism can have very negative consequences on dental and oral health. Over time, people with bruxism can wear their teeth down to flattened surfaces with an even, square appearance. They may even end up with chipped, loose or even fractured teeth. What’s more, grinding and clenching can damage dental restorations such as crowns or fillings and cause premature failure.

Treating Bruxism with a Dental Splint

There are a variety of ways to treat bruxism.

The simplest treatment protects your teeth instantly: An occlusal appliance. This is a custom dental splint designed to be worn while sleeping. It prevents your teeth from touching and it also absorbs bite force. These are different from mouth guards, which are designed to protect your teeth from high-speed foreign objects like baseballs, hockey pucks, or impact with the ground.

Dental splints get high scores in protecting your teeth, but depending on how they are designed, they don’t always discourage the urge to grind, so patients may still suffer from other effects of grinding such as headaches, TMJ issues, and poor jaw mobility.

Other Treatments for Bruxism

There are other potential treatments for bruxism that aim to stop or discourage the grinding behavior, which will help alleviate those non-dental consequences listed above.

These treatments include:

Treatment for airway issues that may be causing the grinding
Prescription medications
Botulinum neurotoxin type A, more commonly known by the brand name Botox
Counter stimulation, such a small electrical impulse that’s activated by clenching
Treating the underlying stress or anxiety that may be causing the bruxism
Behavioral techniques such as biofeedback therapy

Here at Eggert Family Dentistry, Dr. Jeff and Dr. Elizabeth screen for evidence of bruxism during our exams. If your teeth indicate any damage from grinding, we’re here to partner with you in resolving the problem. Likewise, if you’re experiencing any symptoms that could indicate bruxism, such as jaw pain and stiffness, chronic headaches and more, be sure to let us know so we can help you overcome this destructive and uncomfortable activity.

Prolonged teeth grinding or clenching has the potential to damage your teeth irreversibly, so it’s worth taking every possible measure to overcome bruxism and to mitigate its erosive effect on your teeth. We look forward to helping you overcome bruxism and enjoy healthy teeth and reduced jaw and facial tension. Call us today at 651.482.8412 to schedule your next appointment.

The Seattle Protocol – Tom’s Story

By: Dr. Elizabeth Eggert

How Did This Start?

Tom’s journey began in 2014 when he came to us as a new patient looking to improve his oral health and the appearance of his teeth. During his comprehensive exam, Dr. Elizabeth found the main areas of concern to be the excessive wear, erosion and fracturing of Tom’s teeth. Dr. Elizabeth recommended Tom go through the records process (you can learn more about the records process here) and based on the information gathered during that process, she recommended a full-mouth reconstruction to address his uneven bite and rebuild his broken teeth. Throughout the process of reconstruction, it became clear that the amount of force in Tom’s bite was putting too much pressure on even his temporary crowns, which resulted in the temporaries cracking or falling out on more than one occasion. Dr. Elizabeth was concerned that even after completing the full mouth reconstruction, Tom would have underlying issues. Given Tom’s other symptoms, including difficulty breathing through his nose, dry mouth and use of a CPAP machine, Dr. Elizabeth recommended Tom complete the Seattle Protocol to help address his airway patency.

What Was Involved?

The Seattle Protocol is a six-step process that helps patients with symptoms of sleep-disordered breathing and other conditions determine whether a compromised airway is contributing to their ailments. Each step builds upon the last, but patients don’t necessarily need to complete the entire process as the purpose of the protocol is to determine the phase that provides the best relief of symptoms. You can learn more about the Seattle Protocol and each of the steps here. Throughout the process, Tom noticed improvements in his symptoms such as dry mouth, decreased clenching and grinding, and less waking throughout the night.

What Have Tom’s Results Been?

After completing five of the six steps of the Seattle Protocol, Dr. Elizabeth fabricated a sleep appliance for Tom to continue to improve his airway patency, reduce his bruxism and help him sleep better. Tom has now been using his sleep appliance for over a month and says the results so far have been great! He’s noticed less clenching and jaw pain and experienced an overall improvement in his sleep. Tom said that going through the Seattle Protocol helped him better understand the connection between his sleep and airway issues and he appreciates Dr. Elizabeth’s thorough explanation and care throughout each stage.