Oral Appliances for obstructive sleep apnea (OSA)

Overview

Oral appliances, also known as dental devices or mouthpieces, are used to treat obstructive sleep apnea (OSA) by keeping the airway open during sleep. OSA occurs when the upper airway is partially or completely blocked, reducing airflow and causing frequent awakenings throughout the night. These interruptions prevent deep sleep and deprive vital organs of necessary oxygen. If left untreated, OSA can lead to severe health complications and may even be life-threatening. 

Oral appliance therapy helps manage OSA by positioning the mouth in a way that allows better airflow, reducing the frequency of apnea episodes, and improving overall breathing during sleep. 

Types  

There are two primary types of dental appliances used to treat OSA: 

1. Mandibular advancement devices (MADs)
   Mandibular advancement devices (MADs) are the most commonly used oral appliances for treating obstructive sleep apnea (OSA). Also known as mandibular advancement splints, mandibular advancement appliances, or mandibular repositioning appliances, these devices work by moving the lower jaw (mandible) forward. This forward movement also pulls the tongue forward, creating more space in the back of the throat and allowing for improved airflow, thereby reducing the frequency of apnea episodes.
   MADs fit over both the top and bottom teeth and typically consist of two parts connected by screws, hinges, or rubber bands. These devices are adjustable, allowing for the lower jaw’s position to be fine-tuned to optimize airflow. They vary in size, material firmness, connection methods between the top and bottom pieces, and the degree to which the teeth touch when the mouth is closed. Additionally, they offer varying degrees of jaw advancement depending on the individual’s needs.2. Tongue-stabilizing devices (TSDs)
2. Tongue-stabilizing devices (TSDs)
   Tongue-stabilizing devices (TSDs), also known as tongue-retaining devices, are used to treat obstructive sleep apnea (OSA) by pulling the tongue forward using suction. A suction bulb holds the tongue in place, with the tip of the device extending outside the mouth. By moving the base of the tongue forward, TSDs help keep the airway open during sleep, reducing episodes of apnea.
   TSDs are less commonly used than mandibular advancement devices (MADs) but serve as a viable alternative for individuals who cannot use MADs, such as those with insufficiently strong teeth to hold a device in place. Unlike MADs, TSDs do not rely on dental structure and are available over the counter, making them accessible to a broader range of users.
   Both MADs and TSDs are effective options for treating OSA, improving airflow and reducing sleep disruptions. If you think you may benefit from oral appliance therapy, consult with a healthcare provider to determine which option is best for you.

Reasons for undergoing the procedure  

Oral appliances are especially useful for individuals with mild to moderate obstructive sleep apnea who have difficulty using a CPAP (continuous positive airway pressure) machine. CPAP delivers pressurized air through a tube and mask to keep the airways open during sleep and is considered the most effective treatment for enhancing airflow in sleep apnea patients. However, many people find it challenging to consistently use CPAP over time. [Text Wrapping Break] 

Oral appliance therapy, while not as effective as CPAP, can still provide symptom relief for some individuals. In certain cases, a combination of CPAP and oral appliances may be used. For instance, a CPAP machine might be employed at home, while an oral appliance could be used when traveling. Additionally, oral appliances can help reduce the amount of pressurized air required by CPAP, making it easier for some patients to manage their therapy.  

Risk 

During the initial week or two of adjusting to your oral appliance, you might experience some side effects. These symptoms generally improve as you become accustomed to wearing the device.  [Text Wrapping Break] 

Common short-term side effects include:  

• Discomfort in your jaw, teeth, or temporomandibular joint (TMJ).  
• Dry mouth.  
• Gum irritation. 
• Increased saliva production. [Text Wrapping Break] 

Long-term side effects are rare with a properly fitted oral appliance, but when they do occur, they may include:  

• Alterations in your bite.  
• Shifting or loosening of teeth.  
• Changes in jaw muscles or temporomandibular joint (TMJ) function.  

Procedure 

Oral appliances function by advancing the base of your tongue, which enlarges the space at the back of your throat. Some designs attach to your tongue to pull it forward, while most devices focus on moving your lower jaw forward, allowing your tongue to remain in its natural position. [Text Wrapping Break] 

You insert the appliance into your mouth before going to bed and wear it throughout the night, removing it upon waking in the morning.  

Before the procedure  

To diagnose obstructive sleep apnea (OSA), you’ll need to undergo a sleep study. If your sleep specialist determines that an oral appliance is a suitable treatment, you’ll be referred to a dentist for further evaluation and fitting. [Text Wrapping Break] 

During the procedure  

In order to fit you for the mandibular advancement device (MAD), the dentist will:  

• Take an impression of your teeth or perform a 3D scan, along with recording your bite relationship.  
• Send this information to a manufacturer, who will create a custom device based on your dentist’s specifications to ensure a proper fit.  
• Schedule a follow-up visit to fit the device and make adjustments, ensuring it is comfortable and stays securely in place while you sleep.  
• Provide detailed instructions on how to clean and maintain your appliance.  

After the procedure  

The dentist might suggest a follow-up sleep test after you start using your MAD to evaluate its effectiveness. Depending on the results, additional adjustments to the appliance may be necessary. [Text Wrapping Break] 

It typically takes two to four weeks to adjust to wearing a mouthpiece while you sleep. Initially, it might feel unusual, so start by wearing it for just a few hours each night and gradually increase the duration. For most people, using an oral appliance eventually becomes a natural part of their nightly routine.  

Outcome 

Oral appliance therapy can greatly alleviate symptoms of obstructive sleep apnea (OSA), such as daytime sleepiness and difficulty concentrating. Many users experience more restful sleep with fewer interruptions and a reduction or complete elimination of snoring. This therapy offers a viable alternative for those who cannot use a CPAP machine and is also convenient for travel.  

The effectiveness of an oral appliance for treating OSA varies based on the shape of your mouth and the severity of your condition. Some individuals with mild to moderate OSA may find that the appliance fully resolves their symptoms, while others might see only partial improvement and may need to explore additional treatments. [Text Wrapping Break] 

Your dentist will discuss the potential benefits of an oral appliance, as well as its advantages and limitations. Regular dental visits are crucial to monitor your dental health, adjust the appliance as needed, and ensure it remains in good condition. Be sure to bring your device to all future dental appointments for evaluation.