Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.

Practice Parameters for the Treatment of Snoring and Obstructive
Sleep Apnea with Oral Appliances: An Update for 2005
SLEEP, Vol. 29, No. 2, 2006

Did you know that your dentist could stop your snoring and possibly save your life?

Unfortunately not many people are aware of the fact that dentistry has a solution to snoring. But let’s start at the beginning.

Snoring...

Snoring is the first point on a continuum of sleep breathing disorders. The sound occurs because of partial obstruction of the airway in back of the tongue as air passes over loose soft tissue like the uvula (the thing that hangs down in the back of your throat), the soft palate and the back of the tongue. The force of incoming breaths caused these loose tissues to vibrate much like a flag blowing in the wind.

Aside from the highly annoying noise factor, which not so incidentally leads to interpersonal friction and destroyed relationships, snoring can cause a decrease in oxygen coming into the body at night.

The misconception that snoring is a joke was recently refuted by a scientific article published in the journal Sleep * that associated loud snoring with a higher risk of stroke and heart disease when compared to people who do not snore. Yes, that’s right – snoring itself, sawing wood, catching some zzz’s, can cause serious health consequences.

No joke here for sure.

Snoring is part of a continuum...

But snoring is only the beginning of the continuum that ends with obstructive sleep apnea. While snoring is a partial obstruction of breathing during sleep, obstructive sleep apnea is a total obstruction of breathing. That’s right – total obstruction. As a matter of fact obstructive sleep apnea is defined as a cessation of breathing during sleep for a period of 10 seconds or longer. In fact, people with severe sleep apnea can stop breathing hundreds of times a night for periods of time that sometimes can be a minute in length. And during this period of time, no oxygen reaches the brain.

No wonder sleep apnea is related to heart disease, heart attacks, stroke, high blood pressure, diabetes, erectile dysfunction and excessive daytime sleepiness.

But what this got to do with your dentist?

Give me a sec... I'm getting to that.

CPAP - the standard treatment

The primary treatment for sleep apnea is a device called a CPAP. CPAP stands for Continuous Positive Air Pressure delivered through a nasal mask. The air pressure acts as a pneumatic splint supporting the soft tissues in the back of the throat. While it does eliminate snoring, which unfortunately has been considered a cosmetic problem by insurance companies up till now, its primary use is to control obstructive sleep apnea.

While CPAP is always effective, it is not always well tolerated by patients. Skin irritation from the nasal mask, claustrophobia, air leakage and inconvenience are all reasons why many people just don’t like their CPAP machines and why compliance is often low.

That’s where your dentist, or at least dentistry as a profession, comes into the picture…

It turns out that specially educated and trained dentists can construct, fit and manage a small, comfortable device that fits in the mouth that can control snoring and sleep apnea.

Dentistry has developed well over 80 small oral appliances, much like two sided sports mouth guards, that can accomplish support of the airway in back of the tongue. These devices move and hold the lower jaw in a forward position preventing collapse of the airway during sleep. The devices are well tolerated by most patients.

In a position paper** published in 2005, the American Academy of Sleep Medicine stated that

Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. Until there is higher quality evidence to suggest efficacy, CPAP is indicated whenever possible for patients with severe OSA before considering OAs. Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the over- all care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Oral appliances, sometimes known as mandibular advancement devices or mandibular repositioning appliances can be an effective alternative for the management of both snoring and obstructive sleep apnea.

But there are a couple of caveats...

First, there are several products worn in the mouth that are advertised on television and on the web that purport to treat snoring by holding the lower jaw in a forward position. These devices are not approved by the FDA. Sleep apnea is a serious medical problem that can cause death from heart related problems. Self-treatment of this condition can be dangerous to your health since it is not monitored by a health care professional educated in all ramificatioons of sleep medicine. In addition, oral appliances can cause some tooth movement and jaw pain which can only be managed by a trained dentist.

Second, while every dentist is legally allowed to provide oral appliance therapy, effective therapeutic results can only be achieved when the dentist has received additional education in the field of dental sleep medicine. When you seek a dentist to provide oral appliance therapy, be sure to ask about continuing education and experience.

Any questions?

Fell free to contact a dentist trained in dental sleep medicine in your city or town. If no dentist is available, contact us and we will find one for you.

References

* Cardiovascular Disease and Health-Care Utilization in Snorers: a Population Survey. Andrea Dunai, MD, Andras P. Keszei, MD, PhD, Maria S. Kopp, MD,PhD, Colin M. Shapiro, MBBCh, PhD, FRCPC, Istvan Mucsi, MD, PhD, Marta Novak, MD, PhD SLEEP Volume 31, Issue 03, Pages 411-416

**Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update for 2005 An American Academy of Sleep Medicine Report. Clete A. Kushida, MD, PhD; Timothy I. Morgenthaler, MD; Michael R. Littner, MD; Cathy A. Alessi, MD; Dennis Bailey, DDS; Jack Coleman, Jr., MD; Leah Friedman, PhD; Max Hirshkowitz, PhD; Sheldon Kapen, MD; Milton Kramer, MD; Teofilo Lee-Chiong, MD; Judith Owens, MD; Jeffrey P. Pancer, DDS SLEEP, Vol. 29, No. 2, 2006