Standards of Care
Oral appliance therapy is indicated for:
- Patients with primary snoring or mild OSA who do not respond to, or are
not appropriate candidates for treatment with behavioral measures such
as weight loss or sleep-position change.
- Patients with moderate to severe OSA should have an initial trial of nasal
CPAP, due to greater effectiveness with the use of oral appliances.
- Patients with moderate to severe OSA who are intolerant of or refuse treatment
with nasal CPAP. Oral appliances are also indicated for patients who refuse
treatment, or are not candidates for tonsillectomy and adenoidectomy,
cranofacial operations, or tracheostomy.
Oral appliances that treat snoring and obstructive sleep apnea are small
plastic devices that are worn in the mouth, similar to orthodontic retainers
or sports mouth guards. These appliances help prevent the collapse of
the tongue and soft tissues in the back of the throat, keeping the airway
open during sleep and promoting adequate air intake. Currently, there
are approximately 70 different oral appliances available. Oral appliances
may be used alone or in combination with other means of treating OSA,
including general health and weight management, surgery, or CPAP.
Types of Oral Appliances
With so many different oral appliances available, selection of a specific
appliance may appear somewhat overwhelming. Nearly all appliances fall
into one of two categories. 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 Appliances
Tongue retaining appliances function by holding the tongue in a forward
position by means of a suction bulb. When the tongue is in a forward position,
it serves to keep the back of the tongue from collapsing during sleep
and obstructing the airway in the throat.
Mandibular Repositioning Appliances
Mandibular Repositioning Appliances function to reposition and maintain
the lower jaw (mandible) in a protruded position during sleep. This serves
to open the airway by indirectly pulling the tongue forward, stimulating
activity of the muscles in the tongue and making it more rigid. It also
holds the lower jaw and other structures in a stable position to prevent
opening of the mouth.
Oral Appliance Therapy
Oral Appliance Therapy involves the selection, fitting, and use of a specially
designed oral appliance worn during sleep that maintains an opened, unobstructed
airway in the throat. Oral appliances work in several ways:
- Repositioning the lower jaw, tongue, soft palate and uvula
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue
Dentists with training in oral appliance therapy are familiar with the
various designs of appliances. They can determine which one is best suited
for your specific needs. The dentist will work with your physician as
part of the medical team in your diagnosis, treatment, and on-going care.
Determination of effective treatment can only be made by joint consultation
of your dentist and physician. The initial evaluation phase of oral appliance
therapy can take from several weeks to several months to complete. This
includes examination, evaluation to determine the most appropriate oral
appliance, fitting, maximizing adaptation of the appliance, and the function.
Other Treatment Options
In addition to lifestyle changes, such as good sleep hygiene, exercise
and weight loss, there are three primary ways to treat snoring and sleep
apnea. The most common way is with therapy delivered through a Continuous
Positive Air Pressure machine. CPAP is usually applied through a tube
to a mask that covers the nose. The air pressure that is generated splints
the structures in the back of the throat, holding the airway open during
sleep. Treatment can also be accomplished with surgery to the soft palate,
uvula, and tongue to eliminate the tissue that collapses during sleep.
More complex surgery can reposition the anatomic structure of your mouth
and facial bones. Many of these procedures can be performed by an AADSM
member trained as an oral and maxillofacial surgeon.
On-going care, including short- and long-term follow-up is an essential
step in the treatment of snoring and Obstructive Sleep Apnea with Oral
Appliance Therapy. Follow-up care serves to assess the treatment of your
sleep disorder, the condition of your appliance, your physical response
to your appliance, and to ensure that it is comfortable and effective.
Advantages of Oral Appliance Therapy
Oral Appliance Therapy has several advantages over other forms of therapy:
- Oral appliances are comfortable and easy to wear. Most people find that
it only takes a couple of weeks to become acclimated to wearing the appliance.
- Oral appliances are small and convenient making them easy to carry when
- Treatment with oral appliances is reversible and non-invasive.