What Is Oral Appliance Therapy
Oral appliance therapy involves the use of a specially designed oral appliance (looks like an athletic mouth guard) that maintains an open, unobstructed airway in the throat when worn during sleep. Oral appliances are safe, non-invasive, highly effective treatment for snoring for all severities of obstructive sleep apnea. Patients with mild to moderate sleep apnea can try the dental appliance without using C-PAP first. The oral appliances are recommended for patients who have severe sleep apnea, who have tried but cannot tolerate C-PAP. Also, the American Academy of Sleep Medicine recommends oral appliance therapy for patients with mild to moderate sleep apnea. The Oral Appliance is a small plastic device that fits in the mouth during sleep like a sport’s mouth guard or orthodontic retainer. Oral appliances help prevent the collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep to promote adequate air flow. Oral appliances may be used alone or in combination with other treatments for sleep-related breathing disorders.
The American Academy of Sleep Medicine Recommends Oral Appliance Therapy
Candidates for Oral Appliance Therapy
Patients with moderate to severe Obstructive Sleep Apnea who have tried but were not able to tolerate C-PAP are excellent candidates for oral appliance therapy. Good candidates for oral appliance therapy are also patients with primary snoring or mild Obstructive Sleep Apnea (OSA) who do not respond to, or are not appropriate candidates for treatment with behavioral measures, weight loss or sleep-position changes.
“Since I started using the oral appliance my wife said my snoring has pretty much stopped… I have slept consistently through the night more since using the appliance…”
– Shawn Fitzpatrick
Who Provides Oral Appliance Therapy
Dentists trained and Board Certified in oral appliance therapy are familiar with the various designs of appliances and can help determine which is best suited for your specific needs. Your dentist should work closely with your physician to provide medical diagnosis, treatment and ongoing care.
The Oral Appliance Treatment Process
The initial evaluation phase of oral appliance therapy includes examination, evaluation to determine appropriate oral appliance fitting and maximizing adaptation of the appliance.
The secondary phases of treatment includes short and long term follow-up. Follow-up care serves to assess the progress of the sleep apnea therapy, the condition of the oral appliance and the patients’ physical and medical response to the appliance.
Some of the Advantages of Oral Appliance Therapy
- Oral appliances are comfortable and easy to wear
- Oral appliances are small and convenient making them easy to carry when traveling
- Treatment with oral appliances is non-invasive
- Oral appliances do not make noise
The Primary Physiological Impacts of an Oral Appliance
- Moving the lower jaw, tongue, soft palate and uvula slightly forward
- Stabilizing the lower jaw and tongue
- Increasing the muscle tone of the tongue
- Moving the muscles of the front part of the neck forward to open the airway
Mandibular repositioning appliances reposition and maintain the lower jaw in a slightly protruded position during sleep. The device serves to open the airway by directly pulling the tongue forward, stimulating activity of the muscles in the tongue. The device also holds the lower jaw and other structures in a stable position to pull the airway open and prevent the throat from collapsing.
Considerations Must Include
- Medical co-morbidities among other anatomic and physiologic factors
- Affect on the TMJ (temporal mandibular joint)
- Cranio-facial muscles
- Nerves and tissues
- The position of the teeth
- The bite
- Anatomy of the soft palate and other intra-oral tissues
- The nose and nasal tissues
- Size of the tongue and the space available in the mouth
- Gag reflexes
Types of Oral Devices
There are many types and designs of oral appliance to treat OSA. When it comes to oral appliances it’s not a one “once-size-fits-all” undertaking. Appliances should be FDA approved. A trained and experienced dentist treating OSA will custom design an appliance specific to the severity of your condition, the anatomy of your jaws, the arrangement of your teeth, and the area of the airway where the obstruction occurs. There are even appliances that can be constructed for patients wearing full and partial removable dentures.
Is Oral Appliance Right For You?
Once you have completed initial screening, consultation, testing and diagnosis, the suitability of oral appliance therapy should become clear. Few therapies are right for every patient. Oral appliance therapy is no exception.
When oral appliance therapy is indicated and used as prescribed, the results are most often outstanding. In many cases patients report the therapy to be positively life changing.
Post Traumatic Stress & Sleep Apnea
Here’s a frightening fact. People who suffer from Post Traumatic Stress Disorder (PTSD) and sufferers of significant, long term untreated sleep apnea have many psychological and physiological symptoms in common.
One reason for common symptoms between these conditions is the long term over production of cortisol. The brain and the body cannot experience high levels of constant or sustained cortisol saturation without damaging or even disastrous consequences!