Transform your patient's nightlife...

Clinical Information
Before you prescribe a SILENSOR for your patient, we would like to provide you with some additional information on snoring and obstructive sleep apnoea.

Snoring
Studies have shown that approximately 40% of the population of the industrialised countries snore and that this increases to 60% in men above the age of 60.

Most of the noises produced by snoring are generated by vibration of areas of the soft tissues. During sleep, there is a natural relaxation of the muscle tone in the neck and pharynx and the normal firmness of the tissues decreases, resulting in the formation of bottlenecks or even complete obstruction of the airways, especially when the patient lies on their back.

Due to this narrowing of the pharyngeal space, the required volume of air must be respired at a higher velocity to deliver the same quantity of air. This results in stimulation and vibration of soft tissues, such as the velum palatinum (soft palate) and the uvulum.

It has been found that snoring can also be caused by external factors such as corpulence, alcohol or sedatives. A reduction or elimination of any of these may in mild cases be sufficient to remedy the condition.

Obstructive sleep apnoea
Obstructive sleep Apnoea is defined as a respiratory arrest (of more than 10 seconds).

Hypopnea is a decrease in the blood oxygen concentration in blood resulting from a reduction in the respiratory volume during sleep.

At a certain level of severity, this is serious condition that may cause not only sleepiness during the day but also serious secondary effects. The severity of the disease is assessed using the apnoea/hypopnea index, which is calculated by dividing the number of apnoea (longer than 10 seconds) and hypopnea episodes by the number of hours sleep. An index of up to 5 is considered normal, indices of 6-20 or 20-40 are indicative of moderate and sever sleep apnoea, respectively. The index can be determined only in a sleep laboratory.

Referral to a sleep laboratory is urgently indicated, if apnoea is suspected.

Methods of Treatment

ORAL DEVICES
These devices are worn at night and usually operate by displacing the lower jaw forward in an anterior direction in order to achieve the opening of the pharyngeal section of the airways.

Acceptance rates can be as low as 2% but as long as the patient tolerates their use, these devices can be expected to be quite successful in curing the social problem that apnoea poses as well as obstructive sleep apnoea of up to moderate severity. The main reason for patient rejection of these appliances is because of their bulk.

BREATHING MASK
The breathing mask is used for positive air pressure respiration, keeping the airways open. The masks are effective even in severe apnoea cases and are considered the method of choice in these cases. However, the breathing mask must be set up and adjusted in the sleep laboratory. It is a vital piece of equipment although at times may prove inconvenient.

SURGERY
Usually surgery is used to remove respiration-impairing structures, such as enlarged tonsils, adenoids etc. Widely differing success rates of surgery in treating snoring have been reported (20-40%). Success in terms of the cure of apnoea is unsatisfactory.

THE SILENSOR
The Silensor is one of the oral appliances which can be worn at night. Its biggest advantage being that it is non-bulky.

The success of the treatment is largely dependent on the patient's acceptance of the appliance. Obviously, the depth of sleep and comfort of the patient will increase with the reduction in bulk of the appliance.

All these benefits are advantages of the SILENSOR.

The SILENSOR makes use of the fact that the pharyngeal space is enlarged when the lower jaw is displaced in an anterior direction.

The SILENSOR consists of two separate formings which fit over the upper and lower tooth arches. The formings are connected by two lateral rotating connectors which gently pull the lower jaw forward. Any further opening of the mouth increase the anterior displacement of the lower jaw. Despite wearing the SILENSOR, movement of the lower jaw is possible.

Because the SILENSOR is of minimum bulk it is comfortable and an effective anti-snoring aid.

The effectiveness of the Silensor
The SILENSOR has proven highly successful even when breathing through the nose is difficult or blocked, since in almost all cases the noise involved in snoring is caused by constriction of the airways. Similarly, when breathing through the nose is difficult or impossible, e.g. by polyps, use of the SILENSOR is in no way precluded.

The SILENSOR cannot be used in the edentulous mouth. Where removable partial dentures are worn and are firmly retained within the mouth the SILENSOR can be used. In other cases, it must be assessed individually whether the standing teeth will provide sufficient retention of the device.

Important: In cases of suspected sleep apnoea the clinician should refer the patient back to their GP for referral to a sleep disorder clinic.

The SILENSOR is contra-indicated in cases of myofacial disfunction, TMJ disorders, arthropathy of the tempromandibular joint, or advanced periodontal condition.

Patient questionnaire
A SILENSOR questionnaire should be completed by the patient. It may be helpful if the patient completes the form with their partner. The completed questionnaire will give some indication of how their snoring occurs and whether or not the presence of sleep apnoea should be suspected.

Silensor adjustment
If the patient snores only when lying on their back, the SILENSOR can be constructed to the normal biting relationship of the patient, which is a comfortable position for the patient. In such cases it is sufficient to instruct the laboratory that "no protrusion of the lower jaw" is required. The SILENSOR will continue to function successfully when the patient's jaw falls open. A longer or shorter connector can be attached later if necessary. However, "protrusion of the lower jaw" is evident if the patient also snores when the mouth is closed or when lying on the side or front or in cases of mild to moderate apnoea. Forward displacements that are insufficient or intolerable to the patient can be corrected by fitting a different connector.

Wearing the Silensor
Before the SILENSOR is worn the connectors should always be checked to ensure that they are firmly attached.

Adjustments to the Silensor before fitting
The patient's acceptance of the device will be improved by grinding in a multiple -point contract. This procedure closes the bite and may necessitate the use of shorter connector.

Initially, the patient may experience mild discomfort and the mandible may feel slightly out of alignment as lymphatic fluid flows into the TMJ. Lymphatic liquid will be quickly absorbed and consequently feelings of discomfort will rapidly disappear.

Function, acceptance and effectiveness of the SILENSOR should be checked from time to time.

Laboratory requirements
Full upper and lower Alginate Impressions taken to the full depth of the palates and sulcus. Impressions must be taken within rigid metal trays (plastic trays should not be used). Please check the impression to ensure that there are no areas where the impression trays shows through as this will result in a distorted impression and will cause an inaccurate fit.

Model casting procedures
It is essential that the anatomical portions of the impressions are cast in a hard synthetic stone and allowed to set hard before the impression is turned over to be based. It is only at this stage that a further mix of plaster may be made and the impressions turned over to be based. Important: because this appliance fits over that hard tooth structures, accuracy is essential. Casting impressions in one go by turning them over while still soft will cause the forces of gravity to pull the plaster away from the impression interface and create a distorted model.

It is not possible to guarantee the effectiveness, durability and acceptance of the SILENSOR in all cases. However, the large number of successful applications and the sound principles on which the SILENSOR is based make it the most effective and acceptable intraoral anti-snoring and sleep apnoea control device that is available.