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Affinity Dental Care is an airway-centred dental practice focusing on holistic approaches to our patient’s dental health. We have been screening patients for signs and symptoms of sleep-disordered breathing (SDB). It is a term that comprises a range of disorders with varying degrees of significance and severity, including habitual snoring, upper airway resistance syndrome (UARS), and obstructive sleep apnea (OSA). OSA is a sleep disorder in which breathing is compromised briefly during sleep, which is the focus of our practice. It is a serious medical condition leading to partial or complete airway obstruction during sleep. It disrupts the normal sleep cycle and can reduce blood oxygen levels in the body and brain. We work closely with a board-certified medical doctor to help our patients with SDB. He also provides in-person consultations for the patients in our clinic.

Patients with OSA have higher airflow resistance during sleep due to partial or complete collapse of the upper airway, mainly the oropharyngeal tract or the throat. The causes of the collapse could be due to a few factors like too much fat tissue surrounding the airway, the soft palate being too long, soft or flappy that flops into the airway during sleep, a large tongue that drops into the airway when the patient is lying on the back and/or enlarged tonsils and adenoid that block the airway space.

The most common symptoms during sleep are snoring, witnessed apneas, choking at night, nocturia, and insomnia. Snoring may be directly caused by the soft palate hanging into the airway during sleep and vibrating in the wind. Still, multiple factors can contribute to snoring—aging, post-menopause, excessive weight gain, deviated septum and mouth breathing in sleep, etc.

There is one caveat is that not everyone who snores has OSA. However, snoring is not socially attractive and negatively impacts the patient’s and bed partner’s health, well-being and sleep hygiene. This blog does not focus on the different treatment modalities that can treat OSA. It is instead to introduce a novel, innovative treatment that can reduce snoring and shrink the tonsils without surgery.

Affinity Dental Care is fortunate to have an ablative fractional CO2 device that can treat the elongated and floppy soft palate, reducing collapsibility and tightening the palatal tissue through a process of collagen remodelling and neocollagenesis in the underlying tissues just below the surface of the uvula and soft palate. The soft palate and uvula are stiffer and smaller in volume, and that prevents the soft palate from collapsing into the airway during sleep, resulting in an increase in airway volume and a corresponding reduction in the incidence and severity of snoring. The procedure can be done without any anesthetic, and the time is only 5 minutes.

While there are no documented adverse effects of the fractional CO2 laser treatment for snoring, patients may experience tenderness or dryness of the soft palate for up to 24 hours after the treatment. No long-term discomfort has been reported.

Before the introduction of fractional CO2, erbium: YAG laser, also known as NightLase or SleepTight, was used to treat snoring. The treatment requires local anesthesia and takes about 30 to 60 minutes to complete each time.

Comparing fractional CO2 and Er: YAG laser therapy, CO2 is faster, more exact, more effective, quicker recovery, minimally invasive and has fewer side effects than erbium: YAG laser.

Another fantastic new application of the CO2 laser is the reduction of the large tonsils that can impede swallowing and breathing. Substantial shrinkage appeared within 24 hours after the first treatment. The mechanism is similar to remodelling collagen fibres and neocollagenesis stimulation in snoring treatment. Above all, the laser kills bacteria and possible viruses in the inflamed tonsils upon initial exposure to the CO2 laser, reducing inflammatory mediators and toxins produced by the pathogens and resulting in a rapid size reduction.

Below is an actual case of a patient performed by Dr. Wong using a fractional CO2 laser to reduce the tonsils. The patient was suffering from chronic snoring, difficulty in breathing and swallowing, and constant headaches in the morning after waking up from sleep. The symptoms were improved the following day after the therapy.

The tonsils on the left and right are almost in contact with each other.

After 24 hours, the tonsils on the left and right had shrunk, part of the airway became visible. A second treatment using fractional CO2 in 21 days would further shrink the tonsils.

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