Custom made oral appliances move the tongue and lower jaw forward during sleep to maintain an open airway. Utilizing oral appliances is called Mandibular Advancement Therapy (MAT). Dr. Nugent is trained in dental sleep medicine and knows how to select, fabricate, fit and adjust these devices. The oral appliances, which look like mouth guards, help patients breathe freely during sleep by keeping the airway open.
Oral Appliance Therapy is recommended for mild to moderate OSA patients by sleep physicians. For patients that cannot tolerate Continuous Positive Air Pressure (CPAP), oral appliances are an alternative.
Oral Appliances for Sleep Apnea
Oral appliances that are used to treat sleep apnea resemble an athletic mouthguard. However, the oral appliances have more sophisticated features that advance the lower jaw in a slightly forward position. Oral appliances enjoy a much higher acceptance from patients who need sleep apnea treatments.
Older designed oral appliances had limited success in treating OSA and received a poor reputation in sleep disorder medicine. These first generation oral devices held the jaws rigidly and were not adjustable. However, the modern appliance are two-piece adjustable appliances with higher success rates. These oral devices allow a slight lateral jaw movement while holding the mandible in the prescribed forward and vertical position. This feature is critical for people who grind or clench their teeth at night or have histories of TMJ-related problems. With new materials and processing techniques oral appliances are smaller, stronger, and enable smaller adjustment increments.
The characteristics of a professional oral appliance for sleep apnea:
- Requires accurate impression of upper and lower teeth.
- Requires 3-6 clinical appointments to complete and insert.
- Custom fabrication at qualified, professional laboratories.
- Made of elastomeric and rigid dense acrylic for comfort and strength.
- Dense material resistant to odors and stain.
- Adjustable to obtain preferred starting position
- Custom contours create less bulk and improved patient accommodations.
- Incorporated metal components allow finer adjustment increments.
- Excellent durability.
- Anterior, posterior, lateral and vertical adjustments.
The advantages of a dental sleep apnea appliance:
- High patient satisfaction.
- Easier accommodation.
- Smaller adjustment increments.
- Multi-directional adjustments.
- Tough and durable.
- Snug fit.
- Stain and odor resistant.
- Covered by most insurance carriers.
Over the counter appliances are often called “boil and bite” appliances. They consist of a “one-size-fits-all” rigid plastic u-shaped shell approximating the shape of a jaw. The material inside the shell becomes soft when placed in hot water. The heated material is pressed and adapted over the teeth before it reaches a firm, but slightly elastic state at mouth temperature. Over the counter appliances are more bulky, less stable and retentive, and more difficult to accommodate. They are more prone to stain and odor, and are more fragile
CPAP
The historic “Gold Standard” of sleep apnea appliances is still the CPAP (Continuous Positive Air Pressure) machine. Most medical doctors got a brief amount of knowledge about sleep apnea and CPAP. The CPAP is an elaborate air pump with a hose connecting to a mask. This mask is secured over the nose with elastic straps. These machines require electricity to work and ram air down the airway to keep the airway open. They and are 100% effective for 60-70% of the population. However, 30-40% of sleep apnea sufferers cannot tolerate CPAP for a number of valid reasons. Thus, oral appliances can help fill the void for patients who cannot wear a CPAP.
