**19.2. OSA symptoms in children**

**17.1. To summarize**

188 Current Approaches in Orthodontics

individually.

of an OSAS patient [21, 24]:

radiological inspection.

protocol.)

**6.** OA fabrication.

are given to patient.

**1.** Detailed medical and dental history.

**2.** PSG and medical specialist's report investigation.

ing AHI, AI, and snoring.

**1.** MADs are reported more effective than other types of OAs.

**2.** Monobloc-type one-piece and soft-materialed OAs are found to be more efficient in reduc-

**3.** Forward and downward displacement of the mandible is recommended for enlargement in pharyngeal airway area. But this displacement amount should be assessed

**4.** No definite conclusions can be drawn regarding which type or design of OA has a beneficial influence on subjective treatment efficacy. Individually determination of appliance is

The American Sleep Disorders Association (ASDA) has prepared a protocol for OA treatment in OSAS patients. A dental sleep specialist should follow up the stages below in the treatment

**3.** Dental investigation: Soft tissue and intraoral inspection, periodontal-occlusal-TMJ inspection, intraoral habits and parafunction inspection, teeth and restoration inspection, and

**5.** Selection of OA type for the patient individually. (The success and compliance rate varies case to case, and choosing the right type of OA is the most important stage of OA treatment

**7.** Adjustment of the OA. Appliance fit and comfort are controlled, and usage instructions

**8.** Follow-up PSG and lateral cephalogram are taken after appropriate appliance adjustment/ titration and patient adaptation period. Objective determination of the treatment efficiency can only be observed by PSG test with the appliance in place. Nearly all patients report

**9.** If the treatment is found to be effective in the first year of the therapy, four follow-up appointments are recommended. After 1 year, two follow-up appointments per year are enough. At the follow-up appointments, appliance fit, comfort, effectiveness, and patient

positive change subjectively; however, they should be proven with PSG reports.

very important in OA treatment success [10–12, 16, 17, 19, 20, 23, 25–28, 30–32].

**18. Intraoral appliance treatment guideline for OSAS patients**

**4.** Upper-lower dental impressions and bite registration are obtained.

Abnormal breathing during sleeping, frequent awakenings or restlessness, frequent nightmares, enuresis, difficult awakening, excessive daytime sleepiness, hyperactivity-behavior problems, daytime mouth breathing, poor or irregular sleep patterns, early recognition of mouth breathing and airway obstruction; symptoms of recurrent blocked nose; recurrent nasal, ear, and throat infections; parents concerned about snoring should alert the dental professional for definitive diagnosis for pediatric OSA.
