Oral Appliances for Sleep Disordered Breathing
And
Obstructive Sleep Apnea

Oral appliance therapy represents a medically accepted option for a large number of patients diagnosed with a sleep disorder including mild to moderate obstructive sleep apnea. The scientific literature as well as thousands of patient testimonials supports the use of these appliances for the purpose of eliminating or decreasing the symptoms of sleep apnea.

Oral appliance therapy involves the wearing of a relatively small mouthpiece-type device while sleeping. The term oral appliance refers to all devices placed in the mouth whose purpose is to affect upper airway obstruction. Currently there are dozens of these devices available today with new versions being constantly introduced.

The choices are numerous and possibly confusing for the average patient. Therefore, it is imperative that an individual seek the advice of a dental practitioner who has the necessary qualifications as well as adequate experience with these devices. Most dental practitioners with an interest in this field belong to an organization called the American Academy of Dental Sleep Medicine (AADSM). Board certified members of the AADSM usually devote more time to dental sleep medicine in their practices and have met certification criteria established by the AADSM.

Continuous Positive Airway Pressure (CPAP) is still the most predictable and effective way to treat moderate to severe sleep apnea. However, using the CPAP apparatus, especially long term, can be difficult for a significant number of people. This is one reason for the growing popularity of oral appliances. Studies have shown that when patients are given a choice between either CPAP or oral appliances, patients most often preferred oral appliances, especially when the benefit was noticeably strong.

Importantly, a physician or medical sleep specialist should first evaluate all individuals before attempting to wear an oral appliance for the treatment of a sleep disorder. The patient needs to discuss alternative options with his or her sleep physician before starting treatment with a dental appliance. After both patient and physician agree to investigate this treatment choice, it would be best to obtain a formal written prescription for oral appliance therapy to be sent to the dentist along with a copy of the sleep study.

Types of Oral Appliances ^

Two basic types of appliances are used today. They include; first, mandibular advancement devices, and second, tongue repositioners. The most popular devices by far are the mandibular advancement appliances. They are more comfortable, more widely studied and have a greater chance of being effective than the tongue repositioners. Many of these devices are modifications of commonly used orthodontic appliances. Like any other orthodontic or oral appliances, they require a period of consistent nightly wear in order for it to feel comfortable in the mouth. Patient motivation and cooperation are therefore essential to the success of oral appliance therapy.

How Do They Work? ^

The mandibular advancement devices work by positioning the lower jaw and tongue downward and forward. The airway passage is increased not only by the forward positioning of these structures, but also by increasing the tension of the airway muscles. The result is an increase in the size of the airway as well as less relaxation of the muscles associated with the maintenance of the airway during sleep. Numerous studies have demonstrated the effectiveness of these types of appliances.

Tongue repositioners work by pulling only the tongue forward and not the entire lower jaw. The advantage of this design is that the teeth, jaw muscles and joints are less affected. They are, however, not as easily accepted by patients, not as widely used and studied, and have less chance of success due to inadequate retention during sleep. Currently, they are usually used when the mandibullar advancement devices aren't recommended or effective.

What Oral Appliance is Best? ^

There is no single oral appliance that will be the ideal device for every person. What determines the best oral appliance for an individual? This needs to be decided upon after a dentist or orthodontist, experienced in the use of these devices, provides an examination. The examination should include a medical and dental history and an orofacial exam, which evaluates the teeth, gums, jaw joint (TMJ), and soft tissues (tongue, uvula, soft palate and tonsils). A discussion of the pros and cons of oral appliance therapy for that patient's particular situation should follow.

It is in the patient's best interest to speak with first, a medical sleep specialist and then a dental practitioner who is acquainted with the current medical and dental literature concerning oral appliances. It is certainly a joint effort between the patient, the sleep physician, and the dental practitioner in pursuing this treatment option. A listing of dentists who belong to the AADSM can be found at http://www.aadsm.org/

In addition, once a device is fitted, you will need follow-up visits with the dental specialist to ensure that your jaw and teeth remain healthy, that the device fits correctly and that potential side effects are minimized. A follow-up sleep study, reviewed by your sleep physician, is also recommended to accurately evaluate the effectiveness of the treatment. In conclusion, oral appliances are a medically acceptable alternative for a large number of individuals suffering from mild to moderate obstructive sleep apnea. No single therapy works for everyone, whether it is surgery or a device. Fortunately, oral appliances provide an additional treatment alternative for patients suffering from sleep disordered breathing. Do not hesitate to discuss this option with both your sleep physician and dental practitioner.