Oral appliance therapy (OAT) is considered the first line of treatment option available for mild to moderate OSA patients when taking into account both treatment efficacy and patient compliance.
For years (1995-2005) and American Academy of Sleep Medicine (AASM) recognized oral appliances as a less effective, secondary, treatment option. In the February 2006 issue of the journal Sleep they changed their official stance due to published findings over the past several years. In new practice parameters, the AASM stated that oral appliances are an acceptable first line treatment for mild to moderate sleep apnea.
“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 overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures. Follow-up polysomnography or an attended cardiorespiratory (Type 3) sleep study is needed to verify efficacy, and may be needed when symptoms of OSA worsen or recur.
Patients with OSA who are treated with oral appliances should return for follow-up office visits with the dental specialist at regular intervals to monitor patient adherence, evaluate device deterioration or maladjustment, and to evaluate the health of the oral structures and integrity of the occlusion. Regular follow up is also needed to assess the patient for signs and symptoms of worsening OSA. “
Here is a video that explains about oral appliance therapy as an alternative to CPAP.
A majority of oral appliances work to re-position the lower law, thus advancing the tongue and creating a larger opening in the airway. This also serves to prevent the tongue from falling back and creating a blockage. Currently there are over 80 different appliances approved to treat snoring, and nearly 50 appliances FDA approved to treat obstructive sleep apnea.
After an appliance has been delivered and adjusted for maximum comfort and airway caliber (using Pharyngometer) a follow-up sleep study must be performed. This usually occurs 5-6 weeks after appliance delivery and only after the following conditions are met:
1. Patient’s bed partner reports a marked decrease in snoring and any observed apnea events.
2. Patient feels less fatigued and tired during the day.
3. Patient is able to wear the appliance all night without removing it. The patient should be given an ARES device to take home and monitor sleep with the appliance in place. If the patient accidentally removes the appliance during the test, a second test the following night should be performed.
There have been hundreds of studies documenting the efficacy of this treatment. However, there is no way to guarantee that oral appliance will be completely successful for all individuals.
Oral appliances may not reduce snoring or sleep apnea in all cases. Treatment with oral appliances may need to be discontinued if side effects such as sore jaw joints/muscles or excessive tooth movement occur. Other less severe side effects include excessive nocturnal salivation.
Advantages of Oral Appliance Therapy (OAT)
The advantages of oral appliance therapy are clear. The patient is offered a noninvasive, reversible, solution that requires minimal effort to comply with. In addition to the obvious benefits of eliminating snoring, reducing apnea and improving the quality of sleep there are other great benefits of OAT.
High Compliance – Three year compliance with oral appliances has been documented by various studies at nearly 70%. CPAP compliance after just one year is said to be 35%.
Favorable compared to CPAP – In a study published in Chest (Clark, 1996) it was noted that patients preferred oral appliances over CPAP twenty to one.
Highly Effective – As discussed already, appliance efficacy can be as high as 90%
Portable – CPAP is a cumbersome device, especially for people who travel. Oral Appliances are simple and easy to travel with.
Easy to Use – There are no buttons to push or equipment to learn how to set up/take down.
Oral appliance therapy is one of the most effective treatment tools available for OSA. Frequently patients will feel positive results immediately the next morning. It is imperative, however, that all individuals be re-tested with a take home or lab based sleep study to verify appliance efficacy.
Grande Dental Care’s oral appliance procedures and techniques are recognized by the AASM (American Academy of Sleep Medicine), AMA (American Medical Association), ADSM (Academy of Dental Sleep Medicine) and the ADA (American Dental Association).
Dr. Grande has received extensive training in Sleep Disorders Dentistry and is a member of the American Academy of Dental Sleep Medicine.