Michael Simmons, DMD - Family and Cosmetic Dentistry in Tarzana, CA

Oral Appliances are custom fabricated devices that are placed on the teeth at night during sleep. They are adjusted to advance the lower jaw forward in order to keep the airway open rather than closing off entirely by the tongue during the muscle relaxation of deepening sleep. (see photo)

Airway

Oral appliances are found in the scientific literature as early as the mid 1980s. Over time they have evolved to become an adjustable, effective means of exploring the full range of jaw positions. This has allowed dentists now to treat even the most severe cases of obstructive sleep apnea. The American Academy of Sleep Medicine first endorsed oral appliances in 1995 as a safe and effective means of treating snoring and sleep apnea. In the 2005 update, the endorsement of this therapy was upheld and the indications for use were expanded so that they are now the first-line therapy for mild to moderate sleep apnea. They are also approved as the second -line therapy in any level of severity, and for short-term substitutive use (in any level of severity). An oral appliance would be a great back up for a patient who is traveling or camping and does not want to or cannot carry a CPAP machine with them.

How effective this treatment is:
One of the most commonly used devices has demonstrated a 92% adherence rate after 2 years. This was a large study at the University of Melbourne. The chances of success are very good, and the possibility of decreasing risk of stroke, heart attack, diabetes type 2, congestive heart failure, automobile accident, and other causes of decreased longevity is very high, though cannot be guaranteed.

A recent review of the literature, conducted under the auspices of the Standards of Practice Committee of the American Academy of Sleep Medicine established the current effectiveness of oral appliances for the management of snoring and obstructive sleep apnea and gave guidelines to dentists for patient management. If all patient cases published in peer-reviewed medical literature, regardless of severity are combined, as well as all the different appliances, there is a 57% chance of having complete treatment using just an oral appliance.

In the mild category, there is an 81% chance of complete treatment with an oral appliance. In the moderate category, the rate drops to 56%. In the severe category, 25% of patients will have complete treatment using only mandibular repositioning with an oral appliance.

What the side effects associated with the use of an oral appliance are:
Every patient who uses this type of appliance will notice a change in his or her bite every morning. The jaw remains slightly forward when the appliance is first removed. It will feel as if all the load of the bite is on the front teeth, and it is. Patients are instructed in exercises that stretch the muscles that are slightly contracted causing this residual protrusion of the jaw. Both our experience and the literature support the notion that exercises and a daily intervention will restore the bite early and effectively each day, which will presumably also decrease the chance of tooth movement.