WO2015138412A1

WO2015138412A1 - Apparatus and method for delivery and collection of medical gas

Info

Publication number: WO2015138412A1
Application number: PCT/US2015/019641
Authority: WO
Inventors: Tariq Altaf CHAUDHRY
Original assignee: H. Lee Moffitt Cancer Center And Research Institute, Inc.
Priority date: 2014-03-10
Filing date: 2015-03-10
Publication date: 2015-09-17

Abstract

An apparatus comprising a dental tray coupleable to one or more teeth of a subject and the apparatus also comprising an outlet operatively coupled to the dental tray for delivery of a gas to the subject. The apparatus can optionally include an inlet coupled to the dental tray that can receive a gas from the oral cavity of the subject.

Description

APPARATUS AND METHOD FOR DELIVERY AND COLLECTION OF MEDICAL GAS

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of priority to U.S. Provisional Patent Application No. 63/950,512 filed March 10, 2014, the disclosure of which is incorporated herein by reference in its entirety.

BACKGROUND

[0002] Approximately 200,000,000 sedation procedures are performed in the U.S every year. Patient monitoring during sedation procedures can require the use of a nasal cannula with the prongs inserted into the nostrils to deliver oxygen while monitoring exhaled carbon dioxide. A wide range of issues from inaccurate monitoring to patient injury make this setup unreliable with significant room for improvement.

[0003] Nasal insertion of the prongs in patients with oral breathing often leads to a cascade of monitoring issues. Moving the nasal prongs into the patient's mouth is unhygienic but performed regularly in the absence of a better option. Nasal cannulas are insecure and often get dislodged causing loss of C02 capture as well as inability to deliver oxygen into the nostrils. During facial procedures, nasal cannulas get in the sterile surgical field causing a risk for surgical infections.

[0004] Oxygen is heavier than air and tends to settle around the face. Every year several hundred cases of surgical fires causing patient injury are reported when an electrocautery is used. Electrocautery causes sparks and oxygen acts as fuel.

[0005] Approximately two million patients in the U.S are on oxygen therapy either at home or in the nursing homes. Oxygen is delivered through a nasal cannula which is connected to a portable oxygen tank. These patients encounter multiple issues. Nasal cannula tubing has a large surface area that comes in contact with facial skin and long term use can cause skin irritation, dermatitis or skin ulcers. Continuous oxygen flow through the nostrils can cause mucosal dryness. As prevention, humidifier bottles are added but water vapor condensation not only blocks the oxygen flow to the patient, it can also promote bacterial growth in the tubing. Part of the oxygen delivery through the nasal prongs gets wasted during breath exhalation. A typical oxygen tank lasts 4-5 days. It is estimated that 40-60% of the patients on home oxygen therapy continue to smoke. Lighter flame in close proximity to the plastic prongs emitting oxygen causes serious injuries, death and loss of property each year in the U.S.

Therefore the current nasal cannula lacks appropriate safety and reliability.

SUMMARY

[0006] Provided herein is an apparatus comprising a dental tray that may be coupleable to one or more teeth of a subject. The apparatus further comprises an outlet that may be operatively coupled to the dental tray for delivery of a gas to the subject. In one embodiment the medical apparatus also includes an inlet that may be coupled to the dental tray. The inlet can be configured to receive a gas from the oral cavity of the subject.

BRIEF DESCRIPTION OF DRAWINGS

[0007] The following detailed description will be better understood when read in conjunction with the appended drawings, in which there is shown one or more of the multiple

embodiments of the present invention. It should be understood, however, that the various embodiments of the present invention are not limited to the precise arrangements and instrumentalities shown in the drawings.

[0008] Fig. 1A is a perspective view a medical apparatus in accordance with the present disclosure;

[0009] Fig. IB is a back view of a medical apparatus in accordance with the present disclosure;

[0010] Fig. 2 is a perspective view of a medical apparatus in accordance with the present disclosure;

[0011] Fig. 3 is a perspective view of a medical apparatus coupled to teeth in accordance with the present disclosure;

[0012] Fig. 4 is a perspective view of a medical apparatus with a wedge in accordance with the present disclosure; [0013] Fig. 5 is a perspective view of a medical apparatus with a wedge and an elongated handle in accordance with the present disclosure;

[0014] Fig. 6 is a side view of a subject showing a medical apparatus with an elongated handle in accordance with the present disclosure;

[0015] Fig. 7 shows a medical conduit in accordance with the present disclosure;

[0016] Fig. 8 shows of a medical apparatus in accordance with the present disclosure;

[0017] Fig. 9 is a perspective view of a subject showing an adhesive tape and conduit of a medical apparatus in accordance with the present disclosure;

[0018] Fig. 10 is a perspective view of a medical apparatus with a projection in accordance with the present disclosure;

[0019] Fig. 11 is a top view of a medical apparatus in accordance with the present disclosure. [0020] In the drawings, like reference symbols indicate like elements.

DETAILED DESCRIPTION

[0021] The following is a description of several illustrations of a medical apparatus configured to deliver a gas to the oral cavity of a subject. Certain terminology is used herein for

convenience only and is not to be taken as a limitation on the present invention. In the drawings, the same reference numbers are employed for designating the same elements throughout the several figures. A number of examples are provided, nevertheless, it will be understood that various modifications can be made without departing from the spirit and scope of the disclosure herein. As used in the specification, and in the appended claims, the singular forms "a," "an," "the" include plural referents unless the context clearly dictates otherwise. The term "comprising" and variations thereof as used herein is used synonymously with the term "including" and variations thereof and are open, non-limiting terms.

[0022] Figs. 1A, IB, 2, and 8 show examples of a medical apparatus 100, which includes a dental tray 101. The dental tray 101 is coupleable with one or more teeth of a subject. The subject is optionally a human or any other suitable animal. Some examples of teeth can include incisors, canines, pre-molars, and molars. The dental tray 101 is optionally coupled to upper anterior teeth, upper posterior teeth, lower anterior teeth or lower posterior teeth.

[0023] The example medical apparatus 100 can also include an outlet 118. The outlet 118 is operatively coupled to the dental tray 101 and is configured for delivery of a gas. Examples of delivered gases can include medical gases such as oxygen, nitrous oxide and medical air. The outlet 118 is configured so that the gas can be delivered to a subject when the dental tray 101 is positioned in the oral cavity of the subject.

[0024] The example dental tray 101 that can be used to house one or more teeth of a subject optionally includes a plurality of interior walls and a plurality of exterior walls. The plurality of interior walls optionally includes a first interior wall 110 a second interior wall 112, a third interior wall 111, and a fourth interior wall 115. The interior walls define the interior of the dental tray wherein the at least one or more teeth of a subject can be coupled to the dental tray 101.

[0025] Optionally, the first interior wall 110 and the third interior wall 111 are substantially parallel. Additionally, the first interior wall 110 and the second interior 112 wall can also be substantially perpendicular. The interior walls 110, 111, 112, 111 can be further configured to be releasably fitted to one or more of the teeth described above. The plurality of exterior walls optionally includes a first exterior wall 107 a second exterior wall 108, and a third exterior wall 116.

[0026] Optionally, the first exterior wall 107 and the second exterior wall 108 are substantially parallel. Additionally, the first exterior wall 107 and/or the second exterior wall 108 can be substantially perpendicular with the third exterior wall 116. Optionally, the first interior wall 110 and the first exterior wall 107 have a sloped portion 114. Similarly, the third interior wall 111 and the second exterior wall 108 can also have a sloped portion 114. As seen in Fig. 8, in one example, the dental tray 101 can be shaped along an arc wherein some of the interior and exterior walls are bent to allow the formation of the arc. The dental tray 101 can comprise any suitable material including memory shape foam and/or medical plastic.

[0027] The example outlet 118 described above can optionally include medical conduit 102. The medical conduit 102 can transport gases to and/or from the subject. Furthermore, the medical conduit 102 can be connectable to a gas delivery system. Fig. 7 shows an example of a medical conduit 102 wherein the conduit is a plastic elongated tube. The medical conduit 102 optionally has a single channel, multiple channels and/ or coaxial channels.

[0028] The medical conduit 102 is optionally coupled to a portion of the subject. Coupling the conduit to a portion of the subject secures the conduit and helps ensure the delivery of gas to the subject. The medical conduit 102 can be removeably coupled to an interior surface of a cheek of the subject and/or the exterior surface of a cheek. The conduit 102 can be coupled to the interior or exterior of a check through the use of an adhesive tape 124 and/or an adhesive glue as seen in Figs. 2 and 9. The adhesive tape 124 can optionally be singled side or multi sided.

[0029] Referring back to the example outlet 118, the outlet 118 can be opera bly coupled to one of the plurality of interior walls 110, 111, 112, 111. Opera bly coupled as used in this example embodiment, and throughout, means coupled to the dental tray 101 in such a way that when a gas is delivered through the outlet 118 it is directed and exits the outlet in the oral cavity of the subject.

[0030] In one example, the gas is delivered towards one or more teeth of the subject.

Optionally, the outlet 118 is operably coupled to a base 104 as seen in Figs. 1A and B as 112. In one example, the outlet 118 is positioned inside of the base 104 and the gas exits the outlet and into the base 104. The base 104 can be a support structure for the medical apparatus 100. In one example, the base 104 can be made of a porous material that allows gases to diffuse out of it and into the oral cavity of the subject. Base 104 can be optionally coupled to an exterior wall of the dental tray 101. For example, the base 104 can be removeably coupled to the dental tray or permanently coupled. A thickness of base 104 can be determined based on a risk of airway loss of the subject. In one example, the thickness can range from .5 inch to 2 inches depending on the size of the patient's mouth. For instance, the higher the risk of airway obstruction, the larger the thickness of base 104 is needed. The example outlet 118 can optionally be coupled to the base 104 along a tangential distance within the base 104.

[0031] The example outlet 118, is optionally coupled to the dental tray 101 at a point along at least one of the exterior walls. For instance the outlet 118 can be coupled to at least one point along the first exterior wall 107, the second exterior wall 108, and/or the third exterior wall 116. [0032] Referring back to the example medical apparatus 100, the medical apparatus 100 optionally includes an inlet 120 that is coupleable to the dental tray 101. The inlet 120 can be configured to receive a gas from the subject when the tray is positioned in the oral cavity of the subject. Similar to the outlet 118, an inlet 120 can comprise of a medical conduit 102 as described above and can be further connectable to a gas monitoring system. Optionally, the gas received comprises carbon dioxide. Optionally, the gas monitoring system can monitor carbon dioxide.

[0033] An example inlet 120, can be opera bly coupled to one of the plurality of interior walls 110, 111, 112, 111. In this embodiment, an operatively coupled inlet receives gas in the oral cavity and the received gas is optionally transmitted through a conduit for detection.

Optionally, the inlet 120 is operably coupled within a base 104 as seen in Figs. 1A and B as 112. In one example, the inlet 120 is positioned inside of the base 104 and the gas is received by the outlet within the base 104. In one example, the base 104 can be made of a porous material that allows gases to diffuse into and/or out of it. An example base 104 can be coupled to an exterior wall of the dental tray 101. The base 104 can be removeably coupled to the dental tray or permanently coupled. A thickness of base 104 can be determined based on a risk of airway loss of the subject. The example inlet 120 can optionally be coupled to the base 104 along a tangential distance within the base 104. Optionally or additionally, when the subject's top or bottom molar teeth are coupled to the dental tray 101, inlet 120 can be located near the back of the throat of the subject's mouth allowing for capturing of both oral and nasal breathing while also keeping the subject's mouth open due to jaw pressure between the top and bottom molar teeth with the dental tray 101 and base 104.

[0034] Figs. 3-5 show an example medical apparatus 200, which includes a dental tray 201. The dental tray 201 is coupleable with one or more teeth of a subject. The subject is optionally a human or any other suitable animal. Some examples of teeth can include incisors, canines, premolars, and molars. The dental tray 201 is optionally coupled to upper anterior teeth, upper posterior teeth, lower anterior teeth or lower posterior teeth.

[0035] The example medical apparatus 200 can also include an outlet 212. The outlet 212 is operatively connected to the dental tray 201 and is configured for delivery of a gas. The outlet 212 is configured so that the gas can be delivered to a subject when the dental tray 201 is positioned in the oral cavity of the subject.

[0036] The example dental tray 201 that can be used to house one or more teeth of a subject optionally includes a plurality of interior walls and a plurality of exterior walls. The plurality of interior walls optionally includes a first interior wall 203 a second interior wall 216, and a third interior wall 207. The interior walls define the interior of the dental tray wherein the at least one or more teeth of a subject can be coupled to.

[0037] Optionally, the first interior wall 203 and the third interior wall 207 are substantially parallel. Additionally, the first interior wall 203 and the second interior 216 wall can also be substantially perpendicular. The interior walls 203, 207, 216 can be further configured to be releasably fitted to one or more of the teeth described above. The plurality of exterior walls optionally includes a first exterior wall 205 a second exterior wall 204.

[0038] Optionally, the first exterior wall 204 and the second exterior wall 205 are substantially parallel. Optionally, the first interior wall 203 and the first exterior wall 205 have a sloped portion. Similarly, the third interior wall 207 and the second exterior wall 204 can also have a sloped portion. The dental tray 201 can comprise any suitable material including memory shape foam and/or medical plastic.

[0039] The example outlet 212 described above can optionally include medical conduit 102. The medical conduit 102 can transport gases to and from the subject. Furthermore, the medical conduit 102 can be connectable to a gas delivery system. Fig. 7 shows an example of a medical conduit 102 wherein the conduit is a plastic elongated tube. The medical conduit 102 optionally has a single channel, multiple channels and/ or coaxial channels.

[0040] Referring back to the example outlet 212, the outlet 212 can be opera bly coupled to one of the plurality of interior walls 203, 207, 216 of the dental tray 201. Operably coupled means coupled to the dental tray 201 in such a way that a gas is delivered to the outlet 212 and exits into the oral cavity of the subject. In one example, the gas is delivered towards one or more teeth of the subject. Optionally, the outlet 212 is coupled to the dental tray 201 at a point along at least one of the exterior walls of the dental tray 201. For instance the outlet 212 can be coupled to at least one point along the first exterior wall 203, the second exterior wall 207, and/or the third exterior wall 216.

[0041] Referring back to the example medical apparatus 200, the medical apparatus 200 optionally includes an inlet 214 that is coupleable to the dental tray 201. The inlet 214 can be configured to receive a gas from the subject when the tray is positioned in the oral cavity of the subject. Similar to the outlet 212, an inlet 214 can comprise of a medical conduit 102 as described above and can be further connectable to a gas monitoring system. Optionally, the gas received comprises carbon dioxide. Optionally, the gas monitoring system can monitor carbon dioxide.

[0042] Referring back to the example dental tray 201, the dental tray 201 optionally includes a wedge 209 as seen in Fig. 4. The example wedge 209 can be optionally coupled to one of the plurality of exterior walls of the dental tray 201. In one example, the wedge 209 can be coupled to the dental tray 201 by a rail and slot system, adhesive substrate and/or a mechanical fastener. The wedge 209 can comprise of a plurality of surfaces. The wedge 209 can optionally have a first surface 210 and a second surface 218. The first and second surface 210, 218 can be substantially parallel. Optionally a third surface 206 and a fourth surface 208 can also be substantially perpendicular. An example wedge 209 can also have a first and second surface 210, 218 substantially parallel to each other as well as a third surface 206 that is acutely sloped in relation to a fourth surface 208 as seen in Fig. 4. The size of the fourth surface 208 can be determined based on the risk of airway obstruction of a patient. In patients at risk for airway obstruction, a fourth surface 208 can be, in one example, two inches thick and can be used to keep the oral cavity open to provide access for instrumentation in case of an airway emergency. For instance, the higher the risk of airway obstruction, the larger the height of the fourth surface 208. Optionally or additionally, when the subject's top or bottom molar teeth are coupled to the dental tray 201, inlet 220 can be located near the back of the throat of the subject's mouth allowing for capturing of both oral and nasal breathing while also keeping the subject's mouth open due to jaw pressure between the top and bottom molar teeth with the dental tray 101 and wedge 209.

[0043] An example outlet 212 can be operably coupled at a point along any of the surfaces of the wedge. Additionally an example inlet 214 can be operably coupled at a point along any of the surfaces of the wedge. Optionally, the inlet 214 and outlet 212 can be opera bly coupled to wedge so that the conduit 102 resides either within the wedge or outside the wedge.

[0044] Figs. 5-6 show an example wedge 209 as described above which optionally comprise of an elongated handle 220. The elongated handle 220 can be optionally coupled to either the first surface 210 or the second surface 218. The elongated handle 220 can be optionally coupled to the wedge 209 in such a way so that the medical apparatus 200 can be placed, moved, or manipulated from outside of the oral cavity of the subject.

[0045] Figs. 10 and 11 show an example of a medical apparatus 1000 that includes a dental tray 1001. The dental tray 1001 is coupleable with one or more teeth of a subject. The subject is optionally a human or any other suitable animal. Some examples of teeth can include incisors, canines, pre-molars, and molars. The dental tray 1001 is optionally coupled to upper anterior teeth, upper posterior teeth, lower anterior teeth or lower posterior teeth.

[0046] The example medical apparatus 1000 can also include an outlet 1018. The outlet 1018 is operatively connected to the dental tray 1001 and configured for delivery of a gas. The outlet 1018 is configured so that the gas can be delivered to a subject when the dental tray 1001 is positioned in the oral cavity of the subject.

[0047] The example dental tray 1001 that can be used to house one or more teeth of a subject includes a plurality of interior walls and a plurality of exterior walls. The plurality of interior walls optionally includes a first interior wall 1010 a second interior wall 1012, a third interior wall 1011, and a fourth interior wall 1015. The interior walls define the interior of the dental tray 1001 wherein the at least one or more teeth of a subject can be coupled to.

[0048] Optionally, the first interior wall 1010 and the third interior wall 1011 are substantially parallel. Additionally, the first interior wall 1010 and the second interior 1012 wall can also be substantially perpendicular. The interior walls 1010, 1011, 1012, 1011 can be further configured to be releasably fitted to one or more of the teeth described above. The plurality of exterior walls optionally includes a first exterior wall 1007 a second exterior wall 1008 and a third exterior wall 1016.

[0049] Optionally, the first exterior wall 1007 and the second exterior wall 1008 are

substantially parallel. Additionally, the first exterior wall 1007 and or the second exterior wall 1008 can be substantially perpendicular with the third exterior wall 1016. Optionally, the first interior wall 1010 and the first exterior wall 1007 have a sloped portion 1014. Similarly, the third interior wall 1011 and the second exterior wall 1008 can also have a sloped portion 1014. As seen in Fig. 10, the dental tray 1001 optionally includes a projection 1019 from the dental tray 1001. The projection can extend outside of the oral cavity of the subject when the dental tray is positioned n the oral cavity. The dental tray 1001 can comprise any suitable material including memory shape foam and/or medical pastic.

[0050] The example outlet 1018 described above can optionally include medical conduit 1002. The medical conduit 1002 can transport gases to and/or from the subject. Furthermore, the medical conduit 1002 can be connectable to a gas delivery system. The conduit 1002 can be a plastic elongated tube. The medical conduit 1002 optionally has a single channel, multiple channels and/or coaxial channels. Optionally, the medical conduit 1002 can split at a point 1022.

[0051] The medical conduit 1002 is optionally coupled to a portion of the subject. Coupling the conduit to a portion of the subject secures the conduit and helps ensure the delivery of gas to the subject. The medical conduit 102 can be removeably coupled to an interior surface of a cheek of the subject and/or the exterior surface of a cheek. The conduit 1002 can be coupled to the interior or exterior of a check through the use of an adhesive tape and/or an adhesive glue. The adhesive tape can optionally be singled side or multi sided.

[0052] Referring back to the example outlet 1018, the outlet 1018 can be operably coupled to one of the plurality of interior walls 1010, 1011, 1012, 1011. Operably coupled means coupled to the dental tray 1001 in such a way that a gas is delivered to the outlet 1018 and exits into the oral cavity of the subject. In one example, the gas is delivered towards one or more teeth of the subject. Optionally, the outlet 1018 is operably coupled to a base 1004 as seen in Fig. 10 as 1012. In one example, the outlet 1018 is positioned inside of the base 1004 and the gas exits the outlet and into the base 1004. The base 1004 can be a support structure for the medical apparatus 1000. In one example, the base 1004 can be made of a porous material that allows gases to diffuse out of it and into the oral cavity of the subject. Base 1004 can be optionally coupled to an exterior wall of the dental tray 1001. For example, the base 1004 can be removeably coupled to the dental tray or permanently coupled. A thickness of base 1004 can be determined based on a risk of airway loss of the subject. The example outlet 1018 can optionally be coupled to the base 1004 along a tangential distance within the base 1004.

[0053] The example outlet 1018, is optionally coupled to the dental tray 1001 at a point along at least one of the exterior walls. For instance the outlet 1018 can be coupled to at least one point along the first exterior wall 1007, the second exterior wall 1008, and/or the third exterior wall 1016.

[0054] Referring back to the example medical apparatus 1000, the medical apparatus 1000 optionally includes an inlet 1020 that is coupleable to the dental tray 1001. The inlet 1020 can be configured to receive a gas from the subject when the tray is positioned in the oral cavity of the subject. Similar to the outlet 1018, an inlet 1020 can comprise of a medical conduit 1002 as described above and can be further connectable to a gas monitoring system. Optionally, the gas received comprises carbon dioxide. Optionally, the gas monitoring system can monitor carbon dioxide.

[0055] An example inlet 1020, can be operably coupled to one of the plurality of interior walls 1010, 1011, 1012, 1011. Optionally, the inlet 1020 is operably coupled within a base 1004 as seen in Fig. 10 as 1012. In one example, the inlet 1020 is positioned inside of the base 1004 and the gas is received by the outlet within the base 1004. In one example, the base 1004 can be made of a porous material that allows gases to diffuse into and/or out of it. An example base 1004 can be coupled to an exterior wall of the dental tray 1001. The base 1004 can be removeably coupled to the dental tray 1001 or permanently coupled. A thickness of base 1004 can be determined based on a risk of airway loss of the subject. The example inlet 1020 can optionally be coupled to the base 1004 along a tangential distance within the base 1004.

Optionally or additionally, when the subject's top or bottom molar teeth are coupled to the dental tray 1001, inlet 1020 can be located near the back of the throat of the subject's mouth allowing for capturing of both oral and nasal breathing while also keeping the subject's mouth open due to jaw pressure between the top and bottom molar teeth with the dental tray 1001 and base 1004.

[0056] Referring to Fig. 11, an example medical apparatus 1000 includes at least two outlets 1118. Each outlet 1118 can comprise medical conduit. Each medical conduit of each outlet 118 can join together at a point 1122 and further comprise a joint medical conduit 1002. This configuration allows for a gas to be delivered to different regions within the oral cavity of a subject.

[0057] Also provided are methods for delivering medical gas to a subject. An example method comprises positioning a dental tray into the oral cavity of a subject, wherein the dental tray comprises an outlet. The method further comprises coupling the dental tray to one or more teeth of a subject and delivering a medical gas to the subject through the outlet when the dental tray is positioned in the oral cavity of the subject. The medical gas is optionally oxygen. Optionally, the dental tray comprises an inlet and a gas from the subject is received by the inlet and transmitted along a conduit for detection. The received and transmitted gas is optionally a gas respired from the subject. The gas is optionally carbon dioxide.

[0058] Although the subject matter has been described in language specific to structural features and/or methodological acts, it is to be understood that the subject matter defined in the appended claims is not necessarily limited to the specific features or acts described above. Rather, the specific features and acts described above are disclosed as example forms of implementing the claims.

Claims

What is claimed:

1. An apparatus comprising:

a dental tray coupleable to one or more teeth of a subject; and

an outlet operatively coupled to the dental tray that is configured for delivery of a gas to the subject when the dental tray is positioned in the oral cavity of the subject.

2. The apparatus of claim 1, wherein the one or more teeth of a subject is selected from the group consisting of incisors, canines, pre-molars, or molars.

3. The apparatus of claim 1, wherein the one or more teeth of a subject is selected from the group consisting of upper anterior teeth, upper posterior teeth, lower anterior teeth, or lower posterior teeth.

4. The apparatus of claim 1, wherein the dental tray comprises a plurality of interior walls and a plurality of exterior walls.

5. The apparatus of claim 4, wherein the plurality of interior and exterior walls includes a first interior wall, a second interior wall and a third interior wall, wherein the first interior wall and the third interior wall are substantially parallel.

6. The apparatus of claim 4, wherein the plurality of interior and exterior walls includes a first interior wall, a second interior wall and a third interior wall, wherein the first interior wall and the third interior wall are substantially parallel and the first interior wall and the second interior wall are substantially perpendicular.

7. The apparatus of claim 5 or 6, wherein the first interior wall and a first exterior wall have a sloped portion.

8. The apparatus of claim 5 or 6, wherein the second interior wall and a second exterior wall have a sloped portion.

9. The apparatus of claim 5 or 6, wherein the first and second interior wall and the first and second exterior wall have a sloped portion.

10. The apparatus of claim 5 or 6, wherein the first interior wall, second interior wall and third interior wall are further configured to be releasably fitted to the one or more teeth.

11. The apparatus of claim 1, wherein the dental tray further comprises of memory shape foam.

12. The apparatus of claim 1, wherein the outlet comprises medical conduit, wherein the medical conduit is connectable to a gas delivery system.

13. The apparatus of claim 12, wherein the medical conduit comprises a single channel.

14. The apparatus of claim 12, wherein the medical conduit comprises multiple channels.

15. The apparatus of claim 12, wherein the medical conduit comprises coaxial channels.

16. The apparatus of claim 1, wherein the gas delivered to the subject comprises oxygen.

17. The apparatus of claim 12 wherein the medical conduit is removably coupleable to an interior surface of a cheek.

18. The apparatus of claim 12, wherein the medical conduit is removably coupleable to an exterior surface of a cheek.

19. The apparatus of claim 17 or 18, wherein the medical conduit is removably coupleable by use of an adhesive tape.

20. The apparatus of claim 17 or 18, wherein the medical conduit is removably coupleable by use of adhesive glue.

21. The apparatus of claim 19, wherein the adhesive tape is single sided.

22. The apparatus of claim 19, wherein the adhesive tape is multi sided.

23. The apparatus of claim 16, wherein the outlet is operably coupled to one of the plurality of interior walls.

24. The apparatus of claim 16, further comprising of a base, wherein the outlet is operatively coupled within the base.

25. The apparatus of claim 16, wherein the outlet is operably coupled along a tangential distance within the base.

26. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the second exterior wall.

27. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the first exterior wall.

28. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the third exterior wall.

29. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the second interior wall.

30. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the first interior wall.

31. The apparatus of claim 16, wherein the outlet is operably coupled at a point along the third interior wall.

32. The apparatus of claims 4-31, further comprising an inlet, wherein the inlet is operatively coupled to the dental tray such that the inlet is configured to receive a gas from th subject when the tray is positioned in the oral cavity of the subject.

33. The apparatus of claim 32, wherein the inlet comprises a medical conduit that is further connectable to a gas monitoring system.

34. The apparatus of claim 32, wherein the received gas comprises carbon dioxide.

35. The apparatus of claim 32, wherein the inlet is operably couplable to one of the plurality of interior walls.

36. The apparatus of claim 32, further comprising of a base, wherein the inlet is operatively coupled within the base.

37. The apparatus of claim 32, wherein the inlet is operably coupled along a tangential distance within the base.

38. The apparatus of claim 32, wherein the inlet is operably coupled at a point along th second exterior wall.

39. The apparatus of claim 32, wherein the inlet is operably coupled at a point along th first exterior wall.

40. The apparatus of claim 32, wherein the inlet is operably coupled at a point along th third exterior wall.

41. The apparatus of claim 32, wherein the inlet is operably coupled at a point along the second interior wall.

42. The apparatus of claim 32, wherein the inlet is operably coupled at a point along the first interior wall.

43. The apparatus of claim 32, wherein the inlet is operably coupled at a point along the third interior wall.

44. The apparatus of any one of claims 1, 4, 16, or 32, wherein the dental tray further comprises a wedge, wherein the wedge is operatively coupled to one of the plurality of exterior walls of the dental tray.

45. The apparatus of claim 44, wherein the wedge is operatively coupled to the dental tray by a rail and slot system.

46. The apparatus of claim 44, wherein the wedge is coupled to the dental tray by an adhesive substrate.

47. The apparatus of claim 44, wherein the wedge is coupled to the dental tray by a mechanical fastener.

48. The apparatus of any of claim 44, wherein the wedge comprises a plurality of surfaces.

49. The apparatus of any of claim 48, wherein the wedge comprises a first surface and a second surface that are substantially parallel, and a third surface and a fourth surface surface that are substantially parallel.

50. The apparatus of any of claim 48, wherein wedge comprises a first and second surfaces that are substantially parallel to each other, and comprises a third

surface acutely sloped in relation to a fourth surface.

51. The apparatus of claim 49 or 50, wherein the outlet is operably coupled at a point along any of the first, second, third or fourth walls of the wedge.

52. The apparatus of claim 49 or 50, wherein the inlet is operably coupled at a point along any of the first, second, third or fourth walls of the wedge.

53. The apparatus of any of claims 44-52, wherein the dental tray further comprises an elongated handle, wherein an end of the elongated handle is coupled to the wedge.

54. The apparatus of claim 32 further comprising a projection from the dental tray that is configured to extend outside of the oral cavity of the subject when the dental tray is positioned in the oral cavity and wherein the inlet is operatively coupled to the projection.

55. A method, comprising:

positioning a dental tray into the oral cavity of a subject, wherein the dental tray comprises an outlet;

coupling the dental tray to one or more teeth of a subject; and

delivering a medical gas to the subject through the outlet when the dental tray is positioned in the oral cavity of the subject.

56. The method of claim 55, wherein the dental tray further comprises an inlet and wherein gas from the subject is received by the inlet and transmitted along a conduit for detection.