Oral Appliances for snoring & sleep apnoea
What are Oral Appliances and how do they work?
Oral appliances or MAS devices are custom made devices that fit accurately over the upper and lower teeth. They are aimed at repositioning the lower jaw, tongue, soft palate and uvula in a forward direction. They help prevent collapse of the tongue and soft tissues in the back of the throat by stabilising the lower jaw and tongue and increasing the muscle tone of the tongue. These keep the airway open during sleep and promote adequate oxygen intake.
Custom made oral appliances are far superior to generic devices that can be bought over the counter or online. These prefabricated appliances can be bulky and more difficult to continue wearing. The custom made oral appliances are far more reliable and successful in treating sleep apnoea and snoring. Further treatment needs to be carefully monitored and usually a repeat sleep study is required to determine the success of the therapy.
This video features an animation that shows how an oral appliance can prevent the tongue from obstructing the airway and describes the different ways these appliances can open the airway.
Who are oral sleep appliances suitable for?
Oral appliances are well suited for
- Those diagnosed with a primary snoring or upper airways resistance syndrome
- Those who have been diagnosed with a mild to moderate Obstructive Sleep Apnoea (OSA) who prefer it to Continuous Positive Airway Pressure (CPAP) or unable to use positional therapy or weight loss to control their apnoea
- Those with a diagnosis of severe OSA if they cannot tolerate CPAP therapy.
NOTE: Patients with severe OSA should always trial CPAP before considering oral appliance therapy. CPAP is the gold standard of treatment as it can reduce apnoeas to 0.
Only a dentist trained in dental sleep medicine can then provide treatment with oral appliance therapy.
The benefits of oral appliance therapy over CPAP include:
- Ease of use – oral appliances are easy to wear and it takes only a few weeks to adjust to it. The comfort encourages patients to continue wearing the appliances for longer periods of time compared to CPAP
- Small and easy to transport – Oral appliances are discreet, quiet and portable so making it easy to travel with. Unlike CPAP, oral appliances are small enough to fit into your purse or carry-on bag, and are suitable for situations like camping when there is no electricity.
- Treatment with oral appliances is reversible and non-invasive
Side effects of oral sleep appliances
- Excessive salivation
- Dry mouth
- Tooth and jaw discomfort
- Temporary bite changes
However, most of these side effects are minor and resolve quickly on their own or with minor adjustment to the appliance.
Some patients experience potential complications such as jaw pain, permanent bite changes and TMJ symptoms. These complications can be recognized and managed by dentists trained in dental sleep medicine.
Determining suitability and predicting success with dental sleep appliances
As with all treatments, some people respond better than others. There are several indicators that treatment may not be as successful and there are other factors that are predictors of treatment success. A dentist specially trained in Dental Sleep Medicine is well suited to assess your chances of success and advise you if this treatment is not suitable.
If you are interested in investigating whether a dental sleep appliance for snoring or obstructive sleep apnoea is for you, you can either discuss this option with your physician or request a referral to Dr Gonsalvez, or you can book directly with us for a consultation. Either way, we will arrange for a copy of your records and sleep study results for review, prior to treatment.
Frustrated with CPAP? Looking for an alternative?
CPAP is the gold standard in the treatment of Obstructive sleep Apnoea. However research into the acceptability of CPAP shows that 4 out of 10 people can’t tolerate CPAP.
In fact, after 6 months, only 50% of people will wear it for longer than 4 hours a night. This means that for many people, obstructive sleep apnoea is being untreated for half the night, with consequent risks.
The risks of untreated obstructive sleep apnoea
The most common complaints of OSA include snoring, unrefreshed sleep, unexplained tiredness or fatigue or daytime sleepiness or drowsiness.
Obstructive sleep apnoea is also known to increase serious health risks such as:
- Heart disease
- High blood pressure
- Atrial fibrillation
- Increased risk of motor vehicle accidents
- Premature death
- And more
Now, the latest research is also linking the repeated oxygen deprivation to brain injury and the early onset of memory loss or increased risk of dementia.
Oral appliances are a front line treatment alternative to CPAP
Oral appliances for snoring and obstructive sleep apnoea work by opening up the airway at the most common site of collapse. This is at the level of the base of the tongue.
By holding the lower jaw forward during sleep, the tongue which is attached to the lower jaw is also pulled forward. This helps to prevent the tongue base from falling into the back of the throat during sleep.
Whilst they do not reduce obstructive events to the same degree as CPAP, growing research has demonstrated that they are equally effective in terms of reducing health risks. This is after taking into account patient preference, and the average nightly duration of use.
As a result, in 2015, the American Academy of Sleep Medicine updated its Guidelines. It now recommends that oral appliances are better than no treatment, and that they should be offered as a front line treatment alternative to CPAP to patients diagnosed with mild to moderate obstructive sleep apnoea.
If you or someone you know would like to have a local dentist in Point Cook evaluate your suitability for a dental sleep appliance, book an initial consultation with Dr Nomita Gonsalvez at the dental gallery.
Download a copy of “A Guide to Oral Appliance Therapy at the dental gallery” here.