Obstructive sleep apnea (OSA) sufferers may not naturally regard their condition as one best addressed by a dentist. Nevertheless, ask sleep apnea researchers worldwide, and the vast majority will likely confirm that nighttime dental appliances often succeed in limiting interrupted breathing where other ordinarily effective treatments fail to produce consistent results.
Oral sleep apnea appliances are worn strictly during sleep to improve breathing, reduce snoring and restore the benefits of a restful, uninterrupted night’s slumber by maintaining a perfectly clear upper airway. These devices wear like an ordinary orthodontic retainer or common sports mouth guard and maintain unimpeded respiration by gently supporting the lower jaw in a forward position. Although the U.S. Food and Drug Administration has cleared over 100 individual custom-fitted prescription sleep apnea appliances for sale, nearly all fall into one of two general categories:
MANDIBULAR ADVANCEMENT DEVICES (MADs) improve breathing by moving the lower jaw forward, holding the airway’s collapsible portion open with the tongue’s forward movement and support from the airway’s own muscles. This process also improves the airway’s natural strength and rigidity through prolonged muscle activity.
TONGUE RETAINING DEVICES (TRDs While presenting fewer therapeutic difficulties than more commonly prescribed and widely available MADs, the greater discomfort that comes with wearing most TRDs means a longer period of weeks or even months of regular wear before an appliance feels somewhat comfortable.
There is a third, hybrid option that combines dental sleep apnea appliances with Continuous Positive Airway Pressure (CPAP) therapy, arguably the most widely recommended and generally effective treatment for obstructive sleep apnea. As the name implies, a machine delivers a steady airstream through a facemask in order to hold the collapsible airway section open. A custom oral appliance can be fitted directly to the machine to advance the lower jaw forward, allowing the CPAP to operate at a lower and much more comfortable setting. This combination setup is intended to address some patients’ frustrating issues with needing uncomfortably high pressure to successfully open the airway and the facemask’s awkward fit over the nose and mouth.
The good news is, in addition to being largely comfortable and easy to wear properly, dental sleep apnea appliances are conveniently portable for easy travel and come with very simple care instructions. The bad news: it isn’t meant for every patient.
WORDS OF WARNING
Oral sleep apnea appliance therapies are tailored strictly to mild-to-moderate OSA, meaning patients experiencing physical airway obstructions due to anatomical limitations while sleeping. These repeated incidents of interrupted breathing are often caused by a large or floppy tongue, excess throat tissue, nasal obstruction, obesity, or an enlarged uvula and/or tonsils. Among a number of additional variables, your doctor may define your case’s severity according to how many times breathing pauses per each hour of sleep, a measure best taken by way of a clinical sleep study.
The resulting low blood-oxygen levels can cause such serious ensuing conditions as high blood pressure, stroke, congestive heart failure, diabetes, and other potentially life-threatening ailments.
High-moderate or severe OSA patients generally experience little success from oral sleep apnea appliance therapy and are best served by CPAP treatments. Even among appropriate patients, dental devices have the drawbacks of occasional low patient adherence due to discomfort, intolerance, or improper usage that can cause TMJ pain, excessive salivation and dry mouth in the shorter term. Longer-term side effects may include an altered bite, gaps developing between teeth, and even dental misalignment.
Patients should also be advised that an oral sleep apnea appliance may lose its effectiveness over time if the OSA should worsen over the course of several years. Nocturnal bruxism (teeth grinding) can also wear down devices within a few short years to the point they need replaced, sometimes at a substantial cost not always covered by insurance providers. CPAP and/or oral appliance therapies both treat OSA with markedly improved success among patients who transition from sleeping on their backs to their sides and those able to use CPAP most nights at home while switching to a dental device when traveling or sharing a bed with a partner.
Ultimately, should neither CPAP nor oral appliances prove useful, upper airway surgeries including tonsillectormy, adenoidectomy or maxillofacial surgery may prove to be the most viable long-term options. Whichever treatment option you choose to alleviate OSA and/or snoring, proceed in close collaboration with a trusted general health practitioner, sleep therapist, and dentist.