Oral Appliance Therapy For Sleep Apnea & Snoring
Oral appliances (also called Mandibulary Advancement Device or Orthesis) are effective in treating snoring, mild apnea and moderate apnea. They can sometimes be used for severe apnea treatment when CPAP therapy is not ideal. Their objective is to help keep the airway open during sleep.
“Universal” solutions are available in stores or online. We recommend a custom-made device conceived by specialists, as they are more comfortable and pose fewer risks of damage to your teeth.
What is a mandibular advancement brace?
These custom-made devices are adjustable and adapted to your mouth and teeth. An impression of your upper and lower teeth are required.
These soft plastic oral appliances are worn at night. They move the lower jaw, tongue and surrounding mouth areas forward and increase the vertical dimension, enlarging the pharyngeal space, reducing breathing difficulties and keeping the airways mechanically open during sleep. This ensures that breathing is unobstructed.
It is essential to consult a sleep specialist prior to use. He or she will evaluate the chances of success and ensure that your teeth and jaws can support the appliance. These appliances must be designed by sleep specialists and are an effective, non-invasive alternative treatment for snoring and sleep apnea.
Studies have shown that oral appliances are effective in treating snoring for people with the following characteristics:
- Non-obese
- Light snoring
- Mild to moderate obstructive sleep apnea
- Recessed lower jaw
Insurance plans do not always cover oral appliances. Although snoring and sleep apnea are recognized as major public health problems.
Why use oral appliances to treat sleep apnea?
There are a variety of dental appliances available to relieve sleep apnea. The purpose of a dental orthosis is to keep the jaw forward. By repositioning the jaw, the airways are cleared, making it easier for air to pass through. Dental appliances are an alternative to CPAP therapy.
Who can wear dental appliances for sleep apnea?
An orofacial and functional evaluation by a specialist or a dentist qualified in sleep therapy is essential. They will ensure that you are an ideal candidate for oral appliances.
This evaluation includes a complete dental examination. Your teeth and supporting bone structures must be strong enough to support the stresses associated with the device.
The use of these oral appliances require regular monitoring to prevent tooth mobility and temporomandibular joint dysfunction, to evaluate the effectiveness of treatment.
A minimum of eight (8) healthy teeth on each jaw is required to support the device. Having more teeth will reduce the risk of suffering the consequences associated with long-term use.
Possible side effects associated with wearing oral appliances
Most patients do not experience any dental side effects. However, if the teeth are not strong enough, they will tend to move gradually, causing malocclusion (i.e. upper and lower teeth that no longer fit together properly). This leads to varying degrees of discomfort, difficult chewing and irregular teeth erosion.
The oral appliances exert constant pressure on the teeth during the night to reposition the lower jaw in an advanced position. This exerts pressure on the front lower teeth and a posterior tension on the upper teeth.
Patients with orthodontic problems with upper teeth that are too far forward compared to the lower teeth will benefit from having braces because they can partially correct their malocclusion. However, this is not the goal of the treatment. On the other hand, others may have their malocclusion aggravated by the device.
It is important to make sure that the teeth in place are healthy, and they do not have caries or fractures that need to be treated. Dental care performed following the dental appliance design may alter the quality of the adjustment due to the altered teeth shape. To remedy this, the appliance will have to be adjusted or re-shaped.
Instructions and maintenance of oral appliances
Follow these instructions to keep your mandibular advancement device in good condition:
- Brush your device every morning.
- Use half a tablet of Polident or Novadet IP for 10 minutes, 2 to 3 times a week.
- Do not soak in liquid or chemicals.
- Always leave the device inside the box.
Consequences of the oral appliances on the jaw
The jaw must always return to its normal position in the morning (about 1 hour).
If by lunch or dinner your jaw did not return to its original position, stop wearing the device and contact your sleep specialist. There may be temporomandibular joint (TMJ) pain the first morning because of the unusual movement.
If the pain persists or increases after a few days, stop wearing the device and contact your sleep specialist. Don’t wear the device all night on your first night. Wear it one hour before bedtime, and if it is well tolerated, wear it all night. Repeat this the next day until it is well tolerated.
If you are nauseous, remove the prosthesis and try it again the next day until it is well tolerated throughout the night. Once the mandibular advancement device is well-adjusted, a sleep test will be performed to see if the apnea is still present. See if you are less tired during the day. If you sleep with a partner, you can ask if your snoring has decreased. The lifespan of the device is about 3 to 5 years.
Effectiveness of non-prescription dental appliances for treating sleep apnea
For over 20 years, non-prescription dental appliances have been available for treating sleep apnea. However, their effectiveness is limited because these orthoses are designed in a universal mold with no assurance that the selected model will suit the user. As a result, users are easily discouraged because the appliances are too uncomfortable to wear or ineffective.
In contrast, health care professionals must respect certain standards. Non-prescription dental orthotics are not subject to any control. These devices give the illusion that the patient can self-diagnose and obtain adequate treatment.