Oral Appliance Therapy

Oral Appliance Therapy uses appliances worn in the mouth, somewhat similar to sports mouth guards or orthodontic retainers, to reposition the jaw forward during sleep.

Pushing the jaw forward a bit opens the upper airway and helps prevent it from collapsing during sleep.

Effective Treatment for Snoring and Obstructive Sleep Apnea

Oral Appliance Therapy is often the option of choice to treat Snoring, Upper Airway Resistance Syndrome (UARS) or Obstructive Sleep Apnea (OSA). Oral Appliances support the lower jaw and help prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. Oral Appliances are usually used alone, but may be used in conjunction with other forms of therapy such as positive air pressure therapy (PAP), weight loss, and surgery.

Determination of proper therapy is made at Fusion Sleep through a joint consultation of both a dentist, board certified in dental sleep medicine, and one of our sleep physicians.

Types of Oral Appliances

Currently, over 40 different types of oral appliance are available. At our Center, we only use FDA approved appliances of the highest quality, and will choose the device that will work the best for the individual patient.

Mandibular Advancement Devices

The Mandibular Advancement Devices are custom-made for each patient. The device is made of a special heat-sensitive acrylic material that will fit snugly, but comfortably over the upper and lower teeth.  It will support the lower jaw in slightly forward position. This will advance the tongue and soft tissues of the throat to open the airway and restore normal breathing during sleep.

The device has an adjustment mechanism built into it that allows the patient to gradually change the position of the jaw under the dentist’s supervision to maintain its effectiveness. This essential feature often allows for a successful treatment, as optimal jaw position is unique to each patient.

Tongue Retaining Devices

The tongue-retaining device is made of a soft, pliable material with a compartment that fits around the tongue to hold it forward by means of suction. This device is used mostly for patients with dentures or patients who cannot adequately advance their lower jaw. The patient must be able to breathe well through their nose or they may have difficulty tolerating this appliance.

Effectiveness of Oral Appliance Therapy

Research on the effectiveness of Oral Appliance Therapy shows that Oral Appliances are effective in treating snoring in 85-90% of the patients. The Mandibular Advancement Devices are effective in normalizing the apnea levels in 75% of the patients with mild sleep apnea (5 -15 events/hr), 60% effective for patients with moderate sleep apnea (15 - 30 events/hr) and 40% effective for patients with severe sleep apnea (more than 30 events/hr).

Confirming Treatment Effectiveness

Obstructive Sleep Apnea is linked to many chronic diseases. It is therefore essential to confirm efficacy of the treatment. We therefore routinely perform home based sleep studies on patients being initiated on Oral Appliance Therapy to confirm its success or its lack of effectiveness. The study may be easily repeated if changes are made to the adjustment of the device.

Oral Appliance Therapy is initiated under supervision of one of our Board Certified Sleep Physicians, collaborating with our Director of Dental Sleep Medicine. In some cases a laboratory based sleep study may be needed to fully confirm the effectiveness of the treatment.

Indications for Oral Appliance Therapy

The American Academy of Sleep Medicine has stated that oral appliance therapy is indicated as a first treatment option for patients with primary snoring and/or mild  to moderate obstructive sleep apnea and as a second treatment option for patients with severe sleep apnea who cannot tolerate PAP therapy and/or are not good candidates for surgery.

In summary, Oral Appliance Therapy is indicated for:

• Primary/heavy snoring
• Mild or moderate sleep apnea and certain cases of severe OSA
• Poor tolerance of nasal PAP
• Failure of surgery
• Use during travel
• In combination with PAP therapy

Possible Side Effects of Oral Appliance Therapy

There are a number of temporary side effects that may be noticeable during the first few weeks or may require minor adjustments of the appliance by the dentist.

These include:

• Tension in the jaw
• Sore teeth or gums
• Excessive salivation or a dry mouth
• Temporary change in the bite (when appliance is removed in the morning)
• Noises in the jaw joint (TMJ)

The potential side effects that can be more problematic include:

• Jaw muscle or joint pain
• Permanent changes in the bite
• Slight movement of teeth
• Loosening of dental restorations (crowns, bridges, etc.)

From the research evidence and our clinical experience, jaw muscle and joint pain occur in approximately 10% of the patients and the pain disappears when the patient discontinues use of the appliance. The pain can recur for these patients when they start wearing the appliance again. Changes in bite can occur for about 50% of the patients. Although the changes may be slight it may still be difficult for the patient to close their back teeth together, which may have an effect on their ability to chew effectively.

More from the American Academy of Dental Sleep Medicine >>