Oral Appliances

Foreword

Nearly one in four adult patients who sit in a dentist’s chair today has a sleep-related breathing problem. A dentist is often able to spot airway symptoms before anyone else … and one of the leading treatment options for snoring and sleep apnoea is an oral appliance.

What is an Oral Appliance?

A Mandibular Advancement Device ( MAD)  is a  device that can be used to treat some people who have mild or moderate Obstructive Sleep  Apnea (OSA)  and snoring.

 

Oral appliances hold your tongue in place so that your airway stays open while you sleep. Oral appliances are placed into your mouth at night before you go to bed and worn for the entire time you are sleeping and taken out when you are awake.

How do oral appliances work?

Oral appliances work by pushing or pulling your lower jaw forward. By doing this, your tongue is kept in a position that does not block your airway. This reduces the risk of snoring or that your tongue may obstruct your airway during sleep. If this device is helping you, the sound of snoring should be gone entirely or lessened.

How effective are oral appliances?

As with all treatments, not everyone gets the same benefit from oral appliances. For some, the OSA and snoring go away completely, while for other people, other forms of treatment are needed.

 

Oral appliances are more likely to work if you have mild or moderate sleep apnea; more recent evidence supports use for some people with severe sleep apnea as well. If your sleep apnea gets better when you lie on your side (compared to sleeping on your back) and if you are not overweight, you are also more likely to benefit from this appliance.

 

 

How well do oral appliances work compared to CPAP?

CPAP (Continuous Positive Airway Pressure) is the gold standard for treatment of sleep apnea. Immediate results are typically seen with CPAP regardless of how bad the sleep apnea is.

 

An oral appliance will usually improve your sleep apnea, but may not completely control it. If you have moderate or severe OSA, CPAP is more likely to work to correct your sleep apnea than an oral appliance.

 

However, an oral appliance may be a better option than no treatment at all if you cannot tolerate CPAP, oral appliances are also not the main therapy if you have significant heart disease or are very sleepy during the day. In these cases, CPAP is the best treatment.

 

A sleep specialist can provide guidance regarding the most appropriate therapy for you. 

Are there any side effects of using oral appliances?

If fitted well, the oral appliance should be comfortable during the night. However, because it acts to push your jaw forward, some people feel discomfort when first using the appliance. This discomfort tends to improve as you use it more.

 

If discomfort happens, it is usually in the joint at the back of your jaw, just in front of the ear (the temporomandibular joint). This discomfort should go away when you take the appliance out in the morning. Also, oral appliances may cause increased saliva in your mouth, or make your teeth feel tender.

 

These symptoms usually settle down quickly the more you use the device. Over time there may be tooth movement, changes in your bite, or problems with the joints and muscles of your jaw. It is important to have regular follow-up visits with the dentist who supplied you with the appliance to detect and manage problems early.

 

 

How can I get an oral appliance?

Dr Kaplan will refer you to a sleep specialist to find out how bad your sleep apnoea is. This evaluation requires an overnight sleep study which is usually done as a home test.

 

A separate follow-up appointment with Dr Kaplan will follow to talk about the results and discuss possible treatment options .

Does the appliance need to be specially fitted for me?

Each person has a different mouth and jaw shape, so you should have the oral appliance made to fit you. Dr Kaplan will take an impression of your teeth and send the dental impression (dental mold) to the dental laboratory for the appliance to be made.

 

After a few weeks, you will go back to Dr Kaplan’s office, where the appliance is fitted into your mouth. It will be adjusted so that it moves your jaw forward to a position that will be effective but is still comfortable.

 

Dr Kaplan will help supervise the adjustment of the device over several weeks. After the appliance is fitted, follow-up visits with Dr Kaplan or sleep specialist will be needed.

 

There are some kinds of dental devices that you can buy over-the-counter (without a prescription). These devices are cheaper, but they usually do not work. They may take up lots of space in your mouth, pushing your tongue toward the throat and making your OSA worse. Getting the proper fitting device is important in helping your sleep problem.

 

 

How should I care for my oral appliance?

You should brush and floss your teeth before you put your appliance in each night. Dr Kaplan can prescribe fluoride gel to help prevent tooth decay while using your appliance.

 

Plaque can also build upon an appliance. You must therefore clean it daily.  

 

Make sure you dry it out each day before using it again. Also, keep your appliance safely away from children and pets.

How do I know if the oral appliance is working?

When an oral appliance is working well, there should be no snoring. If you are wearing the appliance because of sleep apnea, you may see improved sleepiness, fatigue, and other symptoms of sleep apnea.

 

A good way to find out if you are getting the help you need from your oral appliance is to have a repeat overnight sleep study with the oral appliance in place. If the study shows that wearing the oral appliance has helped your OSA, you should continue to use it every night.

 

If it is not helping your sleep apnea, other treatments (such as CPAP) will be recommended. 

 

 

What do I do if my oral appliance does not seem to be working well?

If symptoms of snoring or sleep apnea return (for example, feeling tired during the day), it is important to have a follow-up appointment with Dr Kaplan or your sleep specialist. Dr Kaplan might need to adjust the appliance.

 

After a number of years, some people using an oral appliance find they need to consider other treatments for their OSA, especially if they have had weight gain. 

RX Action Steps.

Oral appliances may be more convenient than other forms of therapy, but make certain if you use one, it is fitted properly and corrects your sleeping issues.

Speak with Dr Kaplan to find out if an oral appliance may help you.

If your appliance is not making your symptoms better, report back to our office.

Keep follow-up appointments .

Clean your appliance daily.

 

DR Kaplan

Contact Number (011) 483 2281.

 

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