Oral Appliances for Snoring and Obstructive Sleep Apnea
Advantages of Oral Appliance Therapy
Oral appliance therapy has several advantages of other forms of therapy. Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance. Oral appliances are small and convenient making them easy to carry when traveling. Treatment with oral appliances is reversible and non-invasive.
On-going care, including short and long-term follow-up, is an essential step in the treatment of snoring and obstructive sleep apnea with oral appliance therapy. Follow-up care serves to assess the treatment of your sleep disorder, the condition of your appliance, your physical response to your appliance, and to ensure that it is comfortable and effective.
A recently adopted policy by the American Dental Association emphasizes that “dentists are the only healthcare provider with the knowledge and expertise to provide oral appliance therapy (OAT).”
Snoring and Obstructive Sleep Apnea and the Standards of Care
Snoring is the sound of partially obstructed breathing during sleep. While snoring can be harmless, it can also be the sign of a more serious medical condition known as Obstructive Sleep Apnea (OSA). When OSA occurs, the tongue and soft palate collapse onto the back of the throat and completely block the airway, which restricts the flow of oxygen.
ORAL APPLIANCE THERAPY IS INDICATED FOR:
- Patients with primary snoring or mild OSA who do not respond to, or are not appropriate candidates for treatment with behavioral measures, such as weight loss or sleep position change.
- Patients with moderate to severe OSA should have an initial trial of nasal CPAP, due to greater effectiveness with the use of oral appliances.
- Patients with moderate to severe OSA who are intolerant of or refuse treatment with nasal CPAP. Oral appliances are also indicated for patients who refuse treatment, or are not candidates for tonsillectomy and adenoidectomy, craniofacial operations or tracheotomy.
Oral appliances that treat snoring and obstructive sleep apnea are small plastic devices that are worn in the mouth, similar to orthodontic retainers or sports mouth guards. These appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate air intake. Currently, there are approximately 70 different oral appliances available. Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery, or CPAP.
Oral appliance therapy involves the selection, proper fitting, and use of a specifically designed oral appliance worn during sleep that maintains an opened, unobstructed airway in the throat.
Types of Oral Appliances
With so many different oral appliances available, selection of a specific appliance may appear somewhat overwhelming. Nearly all appliances fall into one of two categories. The diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.
Mandibular Repositioning Appliances
Mandibular repositioning appliances function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward, stimulating activity of the muscles in the tongue and making it more rigid. It also holds the lower jaw and other structures in a stable position to prevent opening of the mouth.
Elastic Mandibular Advancement (EMA) Appliance — excellent tongue space, highly adjustable, posterior support.
Oral Appliances Work in Several Ways
- Repositioning the lower jaw, tongue, soft palate and uvula
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue
Dentists with training in oral appliance therapy are familiar with the various designs of appliances. They can determine which one is best suited for your specific needs. The dentist will work with your physician as part of the medical team in your diagnosis, treatment, and on-going care. The initial evaluation phase of oral appliance therapy can take from several weeks to several months to complete. This includes examination, evaluation to determine the most appropriate oral appliance, fitting, maximizing adaptation of the appliance, and the function.
The Dorsal Fin Appliance is comfortable and easy to use.
American Academy of Sleep Medicine Parameters
Oral appliances are appropriate for use in patients with primary snoring who do not respond to or are not appropriate candidates for treatment with behavioral measures, such as weight loss or sleep position change.
Oral appliances are indicated for use in patients with mild to moderate OSA who prefer oral appliances to CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures, such as weight loss or sleep position change.
Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated structures.