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Informed Consent for Dental Appliance Treatment of 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. Mild cases of simple snoring result in little or no following-day symptoms. In more severe cases, the airway completely closes and breathing temporarily stops. This is called an apnea and reduces the amount of oxygen to the body and the brain, and disrupts the normal sleep cycles. The daytime symptoms of sleep apnea vary from mild inability to concentrate to extreme difficulty in staying awake while sitting quietly or driving. Severe cases of sleep apnea can be life threatening. Because sleep apnea is a medical disorder with serious health implications, all --~,- ----pafients~areacfvisecifOconsult\vith theirphysiciaii or asIe-ep disorder specialiSt for diagnosG of their 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 assist breathing by keeping the jaw and/or tongue forward, thereby opening the airway space in the throat causing a reduction in snoring and apnea. While documented evidence exists that dental appliances have substantially reduced snoring and apnea in many cases, there are no guarantees that a dental appliance will be successful or safe for every individual. Several factors contribute to the snoring/apnea problem such as nasal obstruction, narrow airway space in the throat, and excess patient weight constricting the airway." Since every patient is different arid has his/her own set of factors, a dental appliance will not reduce snoring in all individuals, and some patients may not be able to tolerate keeping the appliance in the mouth. Some patients may develop side effects such as temporary excessive salivation, sore jaw joints or jaw muscles, or sore teeth. If these or any other unusual symptoms persist, the patient should stop wearing the appliance and call our dental office to discuss the condition. Patients who have been diagnosed as having sleep apnea may comment that after sleeping with a dental appliance they feel more alert and refreshed during the day. This is subjective evidence of improvement in their apnea condition, but the only way to objectively measure whether the appliance is helping their sleep apnea is to have a follow-up consultation with their physician and, when indicated, a sleep monitoring test with the appliance in place. THIS IS A MUST FOR APNEA PATIENTS. Patients with mild to moderate sleep apnea are better candidates for dental appliances than severe apnea patients. Please sign below indicating that you have read and understand this information concerning dental appliances for the treatment of snoring/or apnea, and that you are willing to accept any risks known and unknown involved in wearing a dental appliance. You will receive a copy of this disclaimer. Patient Date
