Informed Consent for Dental Appliance Treatmentof Snoring/ or Sleep Apnea

Snoring is a sleeplbreathing problem that occurs due to a narrowing of the airway during sleep.This restricts the passage of air and may cause snoring and/or obstructive sleep apnea. Mildcases of simple snoring result in little or no following-day symptoms. In more severe cases, theairway completely closes and breathing temporarily stops. This is called an apnea and reducesthe amount of oxygen to the body and the brain, and disrupts the normal sleep cycles. Thedaytime symptoms of sleep apnea vary from mild inability to concentrate to extreme difficulty instaying awake while sitting quietly or driving. Severe cases of sleep apnea can be lifethreatening. Because sleep apnea is a medical disorder with serious health implications, all

--~,- ----pafients~are acfvisecifO consult\vith theirphysiciaii or asIe-ep disorder specialiSt for diagnosG oftheir snoring or sleep apnea condition before treatment with a dental appliance is begun.

Dental appliances used in the treatment of snoring and sleep apnea are designed to assistbreathing by keeping the jaw and/or tongue forward, thereby opening the airway space in thethroat causing a reduction in snoring and apnea. While documented evidence exists that dentalappliances have substantially reduced snoring and apnea in many cases, there are no guaranteesthat a dental appliance will be successful or safe for every individual. Several factors contributeto the snoring/apnea problem such as nasal obstruction, narrow airway space in the throat, andexcess patient weight constricting the airway." Since every patient is different arid has his/herown set of factors, a dental appliance will not reduce snoring in all individuals, and some patientsmay not be able to tolerate keeping the appliance in the mouth. Some patients may develop sideeffects such as temporary excessive salivation, sore jaw joints or jaw muscles, or sore teeth. Ifthese or any other unusual symptoms persist, the patient should stop wearing the appliance andcall our dental office to discuss the condition.

Patients who have been diagnosed as having sleep apnea may comment that after sleeping with adental appliance they feel more alert and refreshed during the day. This is subjective evidence ofimprovement in their apnea condition, but the only way to objectively measure whether theappliance is helping their sleep apnea is to have a follow-up consultation with their physicianand, when indicated, a sleep monitoring test with the appliance in place. THIS IS A MUST FORAPNEA PATIENTS. Patients with mild to moderate sleep apnea are better candidates for dentalappliances than severe apnea patients.

Please sign below indicating that you have read and understand this information concerningdental appliances for the treatment of snoring/or apnea, and that you are willing to accept anyrisks known and unknown involved in wearing a dental appliance. You will receive a copy ofthis disclaimer.

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