What is the Physiologic Approach?

With multiple years and Fellowships undertaken in the USA, and an additional Australian Fellowship in Sleep Medicine, we add in more than a decade and a half of clinical work successes in sleep disorders and pain management, Dr Maratos doesn't simply take a 'cookie cutter' approach to his patient's symptoms; he treats the individual, and their unique jaw and bite to achieve maximum relief of symptoms. Add to this to the over 35 years Dr Maratos has spent as a Dental Surgeon and working in Family Dentistry & General Dentistry and you have an expert who really is....... The Snore Fix Doctor.

All of our patients are screened for SDB (Sleep Disordered Breathing), OSA (Obstructed Sleep Aponea) and TMD (Temporomandibular Dysfunction). This includes a questionnaire, muscle palpation and intra-oral examination / occlusal assessment, along with an OPG image. (An OPG is also a great diagnostic tool to check for unexpected pathology - like tumours in the jaw bone. ) If Dr Ian suspects SDB, he will prescribe an overnight sleep study which is issued from our practice which is also reported by a Sleep Physician (Dr Ian will also stay in close consultation with the patient’s own Medical Practitioner or Specialist Consultant. ) If anything very complex or sinister is discovered this may necessitate a referral to a Sleep Physician, Ear Nose and Throat (ENT), or Respiratory Physician, or Neurologist for further diagnosis and management.  Dr Maratos may request a CBCT of the neck, TMJs (temporomandibular joint) and airway to rule out more complicated pathology and as a tool in establishing a correct diagnosis and developing an appropriate treatment plan.

If a Mandibular Advancement Splint (or MAS) is prescribed by Dr Ian, or recommended by a referring Specialist, then Dr Maratos is able to construct a unique appliance using a physiologic technique, rather than the typical mechanical method utilising a ‘George Gauge’.  This involves using ultra low frequency TENS, and measuring EMGs to verify true muscle relaxation, thereby ensuring the muscle fibres are at their ideal resting length.   Relaxation via aromatherapy and comfortable reclining in a purpose designed Sleep Room is often utilised to produce a deeply relaxed, meditative state and even lower EMGs.  

In addition, a 3D and perfectly accurate intra-oral scan is also taken of the patient’s dentition, supported by a customised silicone bite is also undertaken as well as a physiologic bite to ensure an absolutely comfortable and perfect fit for the patient. Great are is taken to ensure ideal posture and decompression of TMJs, which is an important clinical objective. This technique results in a MAS with less protrusion, less risk of aggravating or creating a TMD, and less risk of inadvertent teeth movement. 

Follow up includes regular consultations and where indicated, a repeat sleep study with a WatchpatOne Multi and titration, until Dr Maratos is satisfied both subjectively, and objectively with the clinical outcome for the patient. To us, this means the patient is having a good quality sleep nightly and has had significant improvement of their RDI, AHI, and overall energy levels. In some, this can also be a reduction in hypertension and AF symptoms or pain level as well.

* Grinding and Bruxism can often be the vanguard indicator of SDB or OSA.  Grinding can indicate that a neurological response is being attempted to brace and keep the airway protected. It can also be a sign of TMD.

A TMD patient is managed similarly with a sleep screening, as there is a very high correlation between TMD & SDB. Sometimes pain symptoms resolve simply by treating the SDB, however it may be necessary to make a daytime orthotic to position the mandible, neck and muscles in the most relaxed, decompressed position that will allow healing over time.  Grinding and clenching also plays a huge part in TMD issues.

Long term, it may be possible to ‘wean’ the patient off the daytime orthotic, or fabricate a more durable orthotic, or restore the teeth to duplicate the orthotic position, or even treat orthodontically to duplicate the orthotic position which best serves the patient’s well-being. The focus at The Snore Fix Doctor will always be on alleviating pain, maximum comfort and functionality for the patient - and most importantly.....stopping the snoring.