ORAL APPLIANCE THERAPY
OVERVIEW
Oral appliances have been in use for over twenty years to effectively treat snoring and sleep apnea. There are over 40 different FDA approved designs of these devices. Many scientific studies have been done at hospitals and medical universities that demonstrate the usefulness of oral appliances when placed by trained and experienced dentists. Oral appliances are recommended by the foremost medical associations as a first line of treatment for snoring and mild to moderate sleep apnea and for individuals with severe apnea that cannot use CPAP machines.
Oral appliances are small plastic devices similar to an orthodontic retainer or a sports mouth guard. They are used during sleep to position the lower jaw in a slightly forward position. This prevents the relaxed tongue and other soft tissues from collapsing and obstructing air flow. Oral appliances can be used alone or in certain cases along with CPAP or surgery. Determination of proper therapy will be made by your sleep disorders dentist and your sleep physician.
TYPES OF ORAL APPLIANCES
There are two major types of oral appliances in use today. By far the most popular type of device is the mandibular advancement device which gently repositions the lower jaw and tongue forward during sleep. The other type of device is the tongue stabilizing or repositioning device. This device has a small suction bulb that holds the tongue in a forward position during sleep. It is useful where there are no teeth or if there are joint problems.
Dr Chassanoff is experienced with the most popular and effective appliances that are currently used. These include:
- The TAP Appliance (Thornton Adjustable Positioner)
- The PM Positioner
- The EMA Appliance
- The SomnoMed Appliance
- The TRD and TSD (Tongue Retaining Device, Tongue Stabilizing Device)
INDICATIONS FOR ORAL APPLIANCES
Oral appliances are effective for:
- primary/heavy snoring
- mild or moderate sleep apnea and certain cases of severe apnea
- poor tolerance of CPAP
- failure of surgery
- travel
- in combination with CPAP therapy
POSSIBLE SIDE EFFECTS OF ORAL APPLIANCE THERAPY
During the first week or two, there may be increased salivation or tenderness in the teeth or jaws as the mouth becomes accustomed to the appliance. Some individuals will notice a small temporary shift in the bite after the device is removed in the morning. This effect disappears in a few minutes as the jaw repositions itself to its normal position.
A small number of individuals (5-10%) will be unable to tolerate an oral appliance and will discontinue use due to temporary muscle pain. Also, a small number of patients will experience some slight tooth movement in the back teeth.
For the most part, oral appliances are well tolerated and very successful when properly prescribed and inserted by trained and experienced clinicians.
WHAT TO EXPECT DURING TREATMENT
The first step in treatment is proper diagnosis to determine exactly what type of sleep disordered breathing exists. A sleep physician will make this diagnosis based on a medical sleep study and appropriate treatment options will be specified. After that an evaluation by a sleep disorders dentist will determine if you are a good candidate for oral appliance therapy and which appliance to use.
The first dental appointment will involve a discussion of the problem, the advantages and limitations of an oral appliance for you, and your insurance coverage. If it is mutually decided to proceed, impressions will be taken and the appropriate oral appliance will be made at a dental laboratory that specializes in making the chosen appliance. You may also be given a simple in-home base line sleep study to compare with a future in-home test once the device is adjusted.
At your next visit, the custom made device will be inserted, adjusted and care instructions will be given. After that you will need approximately two more visits to make final adjustments. The effectiveness of the device will be judged by the resolution of symptoms and a second in-home sleep test.
When the snoring and daytime sleepiness have been improved, you will be referred back to your sleep physician for final evaluation and most likely another medical sleep study. You will ultimately be followed yearly by your sleep physician and sleep dentist to monitor the sleep apnea and/or side effects.
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