Sleep Apnea Oral Appliance Therapy
Oral Appliance Therapy (OAT) continues to gain in popularity. Resembling removable retainers or sports mouth guards, these oral appliances are made from a soft thermoplastic material, and are custom fitted to the individual wearer by a dental sleep medicine professional.
OATs have proven their effectiveness in several areas of dental sleep medicine. Patients with simple snoring conditions that do not exhibit sleep apnea symptoms often achieve good results with oral appliances. OATs are also considered a primary option for the treatment of mild to moderate Obstructive Sleep Apnea (OSA) among patients who prefer these devices to CPAP. OATs are also an option for all OSA patients who are unable to tolerate, do not respond to, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest greater OAT efficacy, the American Academy of Sleep Medicine recommends CPAP whenever possible for patients with severe OSA before considering oral appliance treatments.
Oral appliances usually fall into one of three general categories: tongue-retaining appliances, mandibular repositioning appliances and combination appliances that are used in conjunction with CPAP. Within these broader categories, there are a number of design variations involving the method of retention, flexibility of material, adjustability, vertical opening, freedom of jaw movement, and construction. Currently, there are more than 100 such appliances approved for use by the FDA. These devices should only be fitted and adjusted by a trained dental sleep medicine professional, who will also help select the device that is most appropriate based on a patient’s individual needs.
Among the most common type of oral appliances are Mandibular Advancement Devices (MADs). These are oral appliances designed to treat snoring and sleep apnea by moving the lower jaw forward slightly, which in turn tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep. The tightening created by the device also prevents the tissues of the upper airway from vibrating as air passes over them – the most common cause of loud snoring.
Over time, the use of certain oral appliances may cause changes to the user’s bite pattern. These changes are usually minor, and not of concern to the patient.
One relatively new type of oral appliance is designed to alter the patients facial structure to create positive changes in the airway. The DNA appliance is employed as an orthodontic tool for the straightening of teeth and reshaping of the mid-facial bones. It has also been shown to improve the airway by expanding the spatial area of the jaw. The DNA appliance will not only alleviate OSA symptoms when in use, but will also effect permanent change that may reduce or eliminate the OSA condition over time.
Many other forms of oral appliance treatments are available such as the Somnomed and the TAP appliance