Sleep apnea is a condition that can significantly impact overall health and quality of life. At Shrivastava Dental Clinic, we offer effective treatment options to help you manage obstructive sleep apnea (OSA) and improve your sleep quality. Oral appliances for sleep apnea are dental devices or mouthpieces that you wear to keep your airway open while you sleep. These devices are often recommended for individuals who cannot tolerate a Continuous Positive Airway Pressure (CPAP) machine. The two main types of oral appliances are mandibular advancement devices (MADs) and tongue-stabilizing devices (TSDs).

What are Oral Appliances for Sleep Apnea?

Oral appliances for sleep apnea are designed to prevent the airway from collapsing during sleep. With obstructive sleep apnea (OSA), the upper airway is partially or completely blocked, leading to interrupted breathing and frequent awakenings. This cycle prevents restful sleep and can lead to serious health issues if left untreated. Oral appliance therapy holds the mouth in a position that ensures proper airflow, helping you breathe better and reducing the frequency of apnea episodes.

Who might benefit from a dental device for sleep apnea?

Dental devices are designed to reposition your jaw or tongue to keep your upper airway open. However, they can be uncomfortable, and it’s difficult to predict who will benefit from using them. People with very mild OSA and minimal symptoms may not experience significant improvement. Therefore, we typically recommend these devices for individuals with mild to moderate OSA or those with severe OSA who cannot tolerate PAP therapy.

Types of Oral Appliances

Mandibular Advancement Devices (MADs)

Mandibular advancement devices are the most common type of oral appliance for treating OSA. They work by pulling the lower jaw (mandible) forward, which also moves the tongue forward, creating more space in the airway. MADs fit over your teeth and are typically made in two parts, one for the upper teeth and one for the lower teeth, connected by screws, hinges, or adapted rubber bands.

Key Features of MADs:

• Size and fit customization.
• Made from various materials (firm or soft).
• Different mechanisms for connecting the top and bottom pieces.
• Adjustable to move the jaw to the optimal position.

Tongue-Stabilizing Devices (TSDs)

Tongue-stabilizing devices use suction to hold the tongue in a forward position, preventing it from blocking the airway. A suction bulb on the device holds the tip of the tongue outside the mouth, creating more space in the throat.

Key Features of TSDs:

• Ideal for individuals whose teeth cannot support a MAD.
• Available over the counter.
• Simple design without the need for dental impressions.

Rapid Maxillary Expansion (RME)

Rapid maxillary expansion (RME) is an orthodontic treatment that uses a device called an expander to gradually widen the upper jaw. The custom-made expander is worn continuously and is designed to fit on the roof of the mouth, attaching to the back upper teeth.

RME is typically recommended for children with obstructive sleep apnea (OSA) who have a narrow upper jaw, a crossbite, or who experience OSA after surgical removal of their tonsils and adenoids. The expander works by gradually separating the upper jaw bones, which can help increase the airway size.

Studies have shown that RME is highly effective in reducing the number of paused breathing events associated with OSA, with up to 25% of children potentially being cured. For some children, combining RME with surgery to remove the tonsils and adenoids may be the most effective treatment for OSA.

Effectiveness of Oral Appliances

Custom-made oral appliances are the most effective for treating OSA. Although over-the-counter options, including “boil and bite” models, are available, custom devices designed by a dentist offer the best results. Some physicians recommend SnoreRx. Instead of starting with an impression of your teeth created by a dentist, you use what the company calls the “boil and bite” method. You place the device in a cup of boiling water for a minute and then bite down on the softened plastic so it molds to your teeth.

How Oral Appliance Therapy Works

Oral appliances pull the base of the tongue and/or the jaw forward, increasing the space in the back of the throat. You wear the device during sleep and remove it in the morning.

Suitable Candidates for Oral Appliance Therapy:

• Individuals with mild to moderate OSA who cannot use CPAP.
• Those seeking an alternative to CPAP, either as a primary treatment or as a supplementary option.
• Individuals traveling frequently who need a portable treatment option.

Who Should Avoid Oral Appliances:

• Individuals with central sleep apnea (due to brain signaling issues).
• Children, unless recommended by a healthcare provider.
• Individuals with severe OSA without medical supervision.

Procedure Details

Getting an Oral Appliance

To receive an oral appliance, you need a sleep study to diagnose OSA. If an oral appliance is recommended, a dentist with expertise in sleep dentistry will provide you with an oral appliance.

Steps to Get a MAD:

1. Dental Impressions or 3D Scans: The dentist takes an impression of your teeth or uses a 3D scan to create a precise model.
2. Custom Manufacturing: The impression or scan is sent to a manufacturer to create the device.
3. Fitting and Adjustments: On a return visit, the dentist ensures the device fits properly and provides instructions for use and care.

Adjusting to an Oral Appliance

It typically takes two to four weeks to adjust to wearing an oral appliance. Initially, you might wear it for a few hours each night, gradually increasing the duration as you become more comfortable.

Risks and Benefits

Short-term Side Effects:

• Excessive salivation.
• Jaw, teeth pain or tenderness of temporomandibular joint (TMJ)
• Dry mouth.
• Gum irritation.

These side effects are generally mild and get better within a few weeks.

Benefits of Oral Appliance Therapy

Oral appliance therapy offers several benefits for individuals with OSA, including:

• Improved symptoms such as daytime sleepiness and concentration issues.
• Deeper, more restful sleep with fewer disruptions.
• Reduced or eliminated snoring.
• An alternative for those who cannot tolerate CPAP.
• Portability for easy use during travel.