Oral Appliance Therapy

Types of Oral Appliances

Currently, over 40 different types of oral appliance are available to specially trained dentists to treat sleep disordered breathing. At first glance, this number appears overwhelming but on close examination each of the appliances falls basically into one of two categories and the diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.

• Tongue Retaining Devices
• Mandibular Repositioning Appliances
• Oral Appliance descriptions
• Caring for your Oral Appliance
• Oral Appliance Approval

Tongue Retaining Devices

There are very few tongue retaining devices available, but they have been well studied and shown to be effective in many patients. Tongue retainers function by directly holding the tongue in a forward position by means of a suction bulb that holds the tongue. When the tongue is in a forward position, the back of the tongue does not collapse during sleep and obstruct the airway in the throat.

An example of a tongue retaining appliance. The tongue is held in the suction bulb that protrudes from between the teeth on this cast.

Mandibular Repositioning Appliances

Mandibular repositioning appliances are by far the most numerous types on the market. They all function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. It is felt that this serves to open the airway by indirectly pulling the tongue forward since the tongue is attached to the lower jaw, by stimulating activity of the muscles in the tongue and making it more rigid, and by holding the lower jaw and other structures in a stable position to prevent opening of the mouth.

An example of a mandibular repositioning appliance.

Thin shells are placed over the upper and lower teeth and a device is incorporated that will pull the lower jaw forward as necessary to open the airway.

Oral Appliance descriptions

	Assured Silence Appliance
	Aveo TSD
	Clasp Retained Mandibular Positioner (CRMP)
	CPAP Pro
	Dorsal Appliance
	Elastic Mandibular Advancement (EMA)
	Elastomeric Sleep Appliance
	FullBreath Appliance
	Herbst
	Hilsen Adjustable Positioner
	Klearway Oral Appliance
	LSWD
	Mandibular Inclined Repositioning Appliance (MIRS)
	MDSA
	Negus
	Nocturnal Airway Patency Appliance (NAPA)
	NORAD
	Nose Breathe Appliance
	OASYS
	OPAP
	OSAP
	PM Positioner
	Silencer
	Silencer - European Silent Nite
	Silensor
	Silent Nite
	Sleep Apnea Goldilocks Appliance (SAGA)
	Sleep-Easy
	Sleepwell
	Snore-Aid
	Snore-Guard
	SnoreFree
	Snorex
	Snore Silencer Pro
	Soft Palate Lifter
	Somnoguard
	Somnomed MAS
	SUAD
	TAP Appliances
	TheraSnore
	Tongue Retaining Device (TRD)
	Z-Appliance

Caring for your Oral Appliance

Clean your appliance each morning wih a toothbrush and toothpaste using COLD water (or as recommended by your doctor) You may also use a sonic cleaner and cleaning tablets at least once a week After cleaning, allow your appliance to air dry Be careful to store your appliance where pets cannot reach it. For some reason, dogs and cats love to chew on these devices. When clening the appliance in the kitchen sink, be careful to keep the drain cover closed.

Oral Appliance Approval

Reprinted from http://www.medpagetoday.com
By Jeff Minerd, MedPage Today Staff Writer
Reviewed by Robert Jasmer, MD; Assistant Professor of Medicine, University of California, San Francisco
February 01, 2006

MedPage Today Action Points

* Consider oral appliances for patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to continuous positive airway pressure (CPAP) systems, who do not respond to CPAP, or who are not appropriate candidates for CPAP.

Review
WESTCHESTER, Ill., Feb. 1 - Oral appliances can be used as a first-line therapy in some patients for treating mild-to-moderate obstructive sleep apnea, according to updated guidelines from the American Academy of Sleep Medicine.

The updated guidelines, based on studies published since the original 1995 guidelines, appeared in the February issue of Sleep.

The previous guidelines recommended continuous positive airway pressure (CPAP) systems as first-line treatment for obstructive sleep apnea. But research suggests that in mild or moderate cases, usually defined as an apnea-hypopnea index from 10-30, oral appliances improve subjective and objective measures of sleepiness about as well, according to Clete A. Kushida, M.D., Ph.D., of Stanford, and colleagues.

CPAP systems are still superior in reducing measures of respiratory disturbances, and for this reason they should remain first-line therapy for patients with severe sleep apnea, the guidelines said.

"Although not as efficacious as CPAP, oral appliances are indicated for use in patients with mild-to-moderate obstructive sleep apnea who prefer oral appliances to CPAP, or who do not respond to CPAP, are not appropriate candidates for CPAP, or who fail treatment attempts with CPAP or treatment with behavioral measures such as weight loss or sleep-position change," according to the guidelines.

In various studies, the success rate of oral appliances hovered just above 50%, but in one study it reached as high as 81% for patients with mild obstructive sleep apnea, the guideline authors noted.

Oral appliances, which resemble athletic mouth guards, may be associated with better compliance than CPAP systems, which many patients find uncomfortable because they require a mask delivering positive pressure to be worn while sleeping, the authors said.

Oral appliances can also be used as a first-line treatment for primary snoring without features of obstructive sleep apnea, the guidelines noted.

Oral appliances should be fitted by a qualified dentist who has experience with the temporomandibular joint, dental occlusion, and associated oral structures, the guidelines said. To verify the efficacy of the device, patients should be followed with polysomnography or an attended cardiorespiratory sleep study.

Patients should have regular follow-up office visits with their dentist to monitor adherence and make sure the device is functioning correctly. Patients should also have regular follow-up with a primary physician or sleep specialist to make sure that symptoms are not worsening, the guidelines said.

The guidelines were issued in conjunction with the Academy of Dental Sleep Medicine .

Source reference:
Kushida CA et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep. 2006; 29(2)

CONCLUSIONS

Occlusal changes can occur with mandibular repositioning appliances. Most changes appear to be of a minor nature, and of little concern to the patients, however some patients can exhibit changes that are detrimental to their occlusion. These changes do not appear to be directly correlated to the degree of protrusion, age, gender or skeletal type. To date cephalometric predictors for at-risk patients are unknown. It is strongly advised that informed consent be given to all patients prior to treatment with mandibular repositioning appliances, this should be combined with routine regular dental reviews with ongoing treatment.

Courtesy of Christopher Robertson, BDS MDS
Robertson CJ Dental and skeletal changes associated with long-term mandibular advancement.
In: Sleep (2001 Aug 1) 24(5):531-7 Complications of oral appliance therapy bibliography

Information provided courtesy of and with permission by www.quietsleep.com