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Oral Appliances

Oral Appliances

An oral appliance is a device worn in the mouth during sleep to keep the soft tissue in the airway from collapsing. While typically not as effective as Positive Airway Pressure (PAP) therapy, an oral appliance is an excellent option for individuals who are unable to tolerate CPAP. While there are a number of different types of FDA-approved oral appliances on the market, they’re all variations on three main themes: mandibular advancement, tongue retention, or a combination of the two. The mandibular advancement devices (MAD) re-position the lower jaw by pushing it forward to create more space for the airway. Tongue-retaining devices (TRD) provide support or stabilization to the tongue to prevent it from falling backward and blocking the airway.

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 and it will hold the lower jaw slightly forward. This will advance the tongue and soft tissues of the throat to open the airway and restore normal breathing during sleep.

The MAD has an adjustment mechanism built into the device that allows the patient to gradually change the position of the bottom jaw under the dentist's supervision to improve the effectiveness of the device. Since the appropriate jaw position to achieve success with treatment is unique to each patient this is a very valuable feature.

The TRD is custom-made using a softer, pliable material with a compartment that fits around the tongue to hold it forward by means of suction. This device is used most 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 Appliances

Research evidence 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 (5-20 events/hr.), 60% effective for patients with moderate sleep apnea (20-40- events/hr.) and 40% effective for patients with severe sleep apnea (more than 40 events/hr.). Patients with moderate or severe sleep apnea must have a follow-up sleep study, while using the oral appliance to confirm the effectiveness of the device and a consultation with the sleep medicine physician to discuss the results.

Indications for Oral Appliance Therapy

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

Therefore, oral appliance therapy is indicated for:

  • Primary/heavy snoring
  • Mild or moderate sleep apnea
  • Poor tolerance of nasal CPAP
  • Failure of surgery
  • Use during travel
  • In combination with nasal CPAP

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 adjustment 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 (i.e. crowns, bridges)

From the research evidence and our clinical experience, jaw muscle and joint pain occur in approximately 10% of the patients and the pain will disappear when the patient discontinues use of the appliance. However, the pain can recur for these patients when they start wearing the appliance again. Changes in the bite can occur for about 20% of the patients. Although the changes may be slight it may still be difficult for the patient to close their back teeth together and this may have an effect on their ability to chew effectively. The slight movement of teeth and loosening of dental restorations occurs very infrequently (1% of the patients) but is still worth noting.

Who can perform Oral Appliance Therapy

Not all dentists are trained to treat sleep apnea, so ask one of our sleep physicians for a referral to a dentist knowledgeable about oral appliances who can recommend a style to match your needs. Your sleep physician may recommend that you have a follow up sleep study to test the effectiveness. It is critical that you follow up with your dentist regularly to ensure the device does not cause your teeth to shift excessively, or your bite to change, and that the device remains effective.


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