Sleep Apnea and Snoring Dental Appliances
A growing treatment for the sleeping disorder known as sleep apnea is Oral Appliance Therapy. Fabricated by a qualified dentist with experience in sleep disorders, this treatment has been used for years as a successful treatment for snoring and some forms of sleep apnea.
In recent years, oral appliance therapy has grown dramatically in popularity, particularly in the United States, and is seen as a welcome alternative to the positive airway pressure, or PAP treatment. The Oral Appliance Therapy treatment involves the use of a sleep apnea dental appliance, usually in the form of a specialized mouthpiece. This sleep apnea dental appliance is an easy to use, comfortable device that works painlessly while you sleep. And unlike a CPAP machine, it is silent, and requires no external hardware or electricity.
The mouthpiece is simply inserted before the patient lies down to go to sleep and it can help to reduce, or sometimes even prevent, the pauses in breathing that is caused by sleep apnea. It is most commonly used for obstructive sleep apnea. Obstructive sleep apnea (OSA) is caused by the relaxation of the muscles involved in the breathing process during the hours of sleep. This relaxation leads to the narrowing of the airways, and eventually it causes the lapses in breathing that are typically associated with sleep apnea. A sleep apnea dental appliance works by shifting the lower jaw during sleep and holding it in place. Adjusting the jaw with this sleep apnea dental appliance keeps the airway open during the times of sleep. By doing this, it helps offset the potential of lapsed breathing when the muscles relax. The airway will be kept open and normal breathing can be maintained throughout the night.
Is a sleep apnea /snoring dental appliance right for you?
Sleep apnea dental appliances are most commonly used for primary snoring and mild to moderate levels of sleep apnea and generally only when it is caused due to obstructive sleep apnea. However, appliance therapy is also indicated for those with more severe levels of apnea when other therapies have failed. Often, the dental appliance can be used with CPAP machines in order to reduce the air pressure necessary for effective treatment.
Most people who have tried both prefer an oral appliance over CPAP. The CPAP device involves the use of pressurized air tanks and the use of face or nose masks, which can be seen as obtrusive and awkward to wear.
If the sleep specialist determines an oral appliance is appropriate for your snoring or sleep apnea, the simple mouthpiece design is a welcome alternative to help with symptoms of sleep apnea while maintaining its low profile. The oral appliance, if recommended, can be a cost effective and simple device alternative to the traditional methods to help return you to healthy, restful, safe sleep patterns.
It is important to remember that treatment with an oral appliance is a process rather than an instant cure. The appliance is a tool that can reposition the soft tissues of the airway in a way that removes the obstruction to breathing. As with any therapy that involves the stretching of muscles and ligaments, it must be done slowly and carefully. This most commonly involves beginning from a very comfortable jaw position, and slowly adjusting the appliance for maximum effectiveness.
Dr. Dioguardi is now in-network with Medicare to provide the sleep apnea appliance as a covered medical service.
Dental appliances used in our office
No one appliance is best for all patients. We use several different oral appliances in our office. The choice of which appliance will be used for each patient is based on many factors including severity of the apnea condition, patient's bite and jaw structure, size of the tongue and soft palate, presence of tooth clenching or grinding, jaw range of motion, health of teeth and gums, along with many other factors. We will use our experience and expertise to help guide the patient to using the appliance that will be most comfortable and effective for that individual's situation. Some examples of these appliances are:
Narval CC is one of the most comfortable oral appliances designed to treat sleep apnea. Unlike most other devices, it is 3D computer printed using a nylon polymer. This custom made device puts your personal comfort first. It is lightweight, flexible and metal free material and gives you the freedom to talk and drink. The Narval is currently the most durable appliance available and is recommended for people who have strong bites or have bruxism.
The SomnoMed MAS™ is an oral appliance, which fits over the upper and lower teeth, much like a sports mouthguard. Unlike a sports mouthguard, however, it is a precision-made, clinically-tested medical device, which in most cases, is highly effective in preventing snoring and mild to moderate obstructive sleep apnea. Unlike other devices, the SomoMed MAS’s upper and lower elements are not connected, resulting in full freedom to open and close your mouth. The medical term for your lower jaw is 'mandible' and an oral appliance worn over the teeth is a 'splint', hence the name SomnoMed Mandibular Advancement Splint, or SomnoMed MAS™.
The Herbst™ is a time-tested hard plastic appliance which has the adjustment hardware set on the cheek side of the molar teeth. It allows jaw movement in all directions except backwards. The Herbst is one of the 'yardsticks' used by other appliances seeking FDA acceptance and is one of the few appliances approved for Medicare reimbursement. It is generally not as comfortable as alternative devices.
The E.M.A.™ is the thinnest and least bulky of all the appliances. It is similar to clear acrylic orthodontic retainers, and the 'hardware' (located on the cheek side of the molar teeth) consists of specially designed, patented elastic bands. This appliance moves the jaw forward in fairly significant steps, which may be difficult to tolerate. Some care must be taken to avoid breaking the lower portion when replacing the custom elastics. It is sometimes recommended for patients with TMJ issues, as the elastic bands provide a dampened endpoint to jaw movements. It has no metal and can be used by patients with a nickel metal allergy.