Oral Appliance Therapy

Oral Appliance Therapy
  • What is an oral appliance?

An oral appliance is a small acrylic device that fits over the upper and lower teeth or tongue (similar to an orthodontic retainer or mouth guard).

  • What does this oral appliance do?

This device slightly advances the lower jaw or tongue, which moves the base of the tongue forward and opens the airway. This improves breathing and reduces snoring and apnea.

  • Is it easy to manipulate?

The appliance is fabricated and customized for each patient by a dentist . The appliances are comfortable and well tolerated by the patients. They are easy to place and remove, easy to clean and are convenient for travel.

  • What are the types of oral appliance?

The two main categories of oral appliances currently in use are the mandibular advancement devices (MAD) and the tongue retaining devices (TRD).

MAD  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 MADs have 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 tongue retaining device 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.

  • What to expect?

The patient after explaining his / her condition, will have an oral impression taken by the dentist or the assistant, and some measurement too.

  • What happens if a patient have very few or no teeth?

Tongue Retaining Device (TRD) is a custom-made appliance made of a soft, pliable material that has a compartment in which the tongue is held in place by means of suction. This appliance is most frequently used for patients who have very few or no teeth. The TRD may require some time for the patient to adapt to having their tongue held in place, so a tongue exercise and adaptation program is started a few weeks prior to the date of insertion of the device. This appliance may be difficult to tolerate if the patient has trouble breathing through their nose.

  • How effective is the oral appliance?

    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.

  • What are the 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 CPAP 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:

1. tension in the jaw
2. Sore teeth or gums
3. Excessive salivation or dry mouth
4. Temporary change in the bite (when appliance is removed in the morning.)
5. Noises in the jaw joint

The potential side effects that can be more problematic include
1. jaw muscle or joint pain
2. permanent changes in the bite
3. Slight movement of teeth
4. Loosening of dental restorations (bridges crowns)

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.

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