Top Dentists 2013

Apnea Bites

Snoring through an intramural feud.

By Catherine Matusow June 1, 2013 Published in the June 2013 issue of Houstonia Magazine

It’s an all-too-familiar story. A man snores loudly, then goes several seconds without breathing. His bedmate, alternately terrified and aggravated, kicks the man awake. The scene repeats itself hour after hour, night after night. Both are tired and forgetful during the day. The relationship suffers.

What happens next is equally familiar: man finally wises up, sees a doctor, does a sleep study, is diagnosed with sleep apnea and given a CPAP. Thus, his airway is kept open, the oxygen continues to flow, and a potentially life-threatening condition is kept at bay, all thanks to a machine, a mask, and the hose that connects them. 

And therein lies the problem. CPAP machines are only an effective means of treating sleep apnea when people use them. Some patients, understandably, don’t like going to bed looking like they’re wearing a gas mask; others report trouble getting a comfortable fit. “The problem is compliance,” says Houston orthodontist Donald E. Frantz. “It’s not very romantic. It treats the patient, but if they hate it, they take it off, or don’t wear it.” And untreated apnea is dangerous. “There are major cardiovascular consequences–strokes, heart attacks. It is a killer if not treated.”

Enter Frantz’s invention, called EMA, which stands for Elastic Mandibular Advancement. The device, which looks like a clear retainer and is worn during sleep, uses elastic bands to pull the bottom jaw forward, opening up the air passageway and allowing the patient to breathe. Frantz says that the EMA is both comfortable and “patient-friendly”–in other words, it has a good chance of actually being used. 

Gail Demko, an expert advisor to the FDA in the field of oral appliance therapy, says the EMA is among some 88 devices approved by the FDA for treating sleep apnea. “We no longer look at whether the devices work,” she says. “We know they work.” 

So why is CPAP still the most common prescription for apnea? Because it’s difficult to get dentists and doctors to work together, according to both Frantz and Demko. Apnea is a medical condition, and the newer treatments come from the world of dentistry.

“The use of oral appliances is absolutely the future of treating sleep apnea,” says Demko, “but it has to be done with a team. My big push is to get dentists into sleep centers where they can treat the patient with a proper team approach between the ear, nose, and throat doctors, dentists, and sleep doctors.” 

As you might expect, Frantz is a one-man proselytizing machine for his oral appliance. Most recently, he discovered that the roofer for his house in Katy suffered from undiagnosed apnea.  

“I made an appliance for the roofer,” says Frantz, “and he said, ‘I can’t believe the change it’s made in my life.’”

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