Oral Appliance Therapy
Sleep apnea, the closing of the airway during sleep, is generally treated with the use of a CPAP machine. However, CPAP may not be effective for everyone, whether the user is not able tolerate CPAP, or the condition may not be severe enough. In these cases an oral appliance, which fits to the top and bottom teeth, and moves your jaw forward to open the airway, is one method that has proven to be a viable option when CPAP fails. There are numerous types and brands of oral appliance, a sleep physician and/or dentist will help choose the best one for your needs.
Oral Appliance Therapy (OAT) is a very effective treatment for snoring and mild to moderate sleep apnea. Sixty five percent of people diagnosed with sleep apnea are mild to moderate apnea, and most individuals find OAT more comfortable and much less cumbersome than CPAP. There are two types of oral appliances: custom and non-custom. Custom devices are generally more effective and are typically covered by medical insurance.
Before being fitted for a dental device, an evaluation for obstructive sleep apnea must be performed by a board-certified sleep physician. This requires an overnight polysomnograph at a sleep lab and will confirm or deny the presence of sleep apnea. The sleep physician will look at the severity of the disease and shape of the airway to determine if an oral appliance is a viable option. In most cases, a trial of CPAP must be attempted, as CPAP is regarded as the more effective at treatment of sleep apnea than alternative treatments. If CPAP fails to treat the disorder sufficiently, or the user is not able to tolerate the machine, the sleep physician may refer the patient to a dentist for a consultation.
Specially trained Dentists, known as ‘Sleep Dentists’, are able to custom fit an Oral Appliance. This involves a series of appointments that include an oral exam, x-rays, impressions, fitting and adjusting. The objective of most OAT’s is to move the lower jaw forward during sleep which helps maintain an open airway, thereby eliminating snoring and sleep apnea. Oral appliances are typically composed of an upper and lower tray that fit over the teeth much like a sports mouth guard.
During the full dental exam the dentist will look for the following in order to qualify for an oral appliance:
1) 6 to 10 healthy teeth on both the top and bottom
2) Ability to jut out your jaw
3) No evidence of TMJ
If you have dentures, you may not be able to wear a dental device.
Once the above has been established, the device will be fitted by a dentist and can be adjusted to allow for greater opening of the airway. It may take a few adjustments to find the appropriate setting – one that is tolerated. As with treatment for any disorder or disease, there may be side effects. These can include dry mouth, tooth pain, or muscle pain.
What makes an effective Oral Appliance?
1. The most effective oral appliances are retentive to the teeth. In order to achieve this an oral exam by a dentist is required to determine if you are a good candidate.
2. The appliance should have the ability to move the lower jaw out beyond maximum protrusion over time. This process can take up to two months.
3. The device should to be adjustable by the patient while in the mouth, which eliminates unnecessary visits back to the Dentist.
Follow-up testing must be completed to show that the dental device treats the sleep apnea sufficiently. In most cases, this requires another overnight sleep study. However, other testing may be done such as a Maintenance of Sleepiness Test to determine how easily you fall asleep during the day; a Maintenance of Wakefullness Test to determine how alert you remain throughout the day; or a nocturnal oximetry, which is a portable device used on your finger to detect abnormalities in your blood oxygen levels during sleep periods. A series of questionnaires should be filled out during follow-ups with both your board-certified sleep physician and your dentist. These questionnaires will let the physician know how you are tolerating the therapy, how sleepy you remain (if at all), and will allow them to see if there has been a change in your quality of life since starting treatment.
Use and Care of your Oral Appliance
To achieve maximum effectiveness, Oral Appliances must be worn every night. Caring for your appliance is simple with daily use of a toothbrush and mild soap for cleaning. Traveling is easy too, with a small carry case your appliance will fit in a travel bag or coat pocket.
The choice of treatment is yours.
Independent studies have shown that patients prefer OAT 20 to 1 over CPAP therapy. Low maintenance and ease of travel make it a great option for treatment. Studies show that over 90% of OAT users wear their appliance every night.
Please, speak with your physician if you are interested in obtaining a dental device to treat your sleep apnea. Open, honest discussions with your physician will help you and the physician determine the correct therapy for your needs.