Treating obstructive sleep apnea (OSA) in those who have it is of utmost importance because of the many risks associated with this disorder. People with OSA stop breathing multiple times throughout the night due to physical blockages of the airway1. As a result, they often experience daytime tiredness, headaches, trouble concentrating, and other symptoms. These symptoms may interfere with their work life, relationships, and ability to drive safely. People with OSA also face an increased risk of stroke, heart attack, and high blood pressure, among other issues.
What Are Oral Appliances for Sleep Apnea?
Oral appliances are devices put in the mouth to help keep a person’s airway open as they sleep. Two oral appliances are generally used for adults with OSA, and a third is available for children with OSA. People are usually prescribed oral appliances by their sleep specialist, but sometimes they are handled by an orthodontist or dentist. Although these appliances may reduce snoring, they differ from anti-snoring devices available in stores, many of which have not been studied as OSA treatments.
Mandibular Advancement Device (MAD)
A mandibular advancement device (MAD) connects to both the upper and lower teeth in order to advance or move the jaw forward. Sometimes called mandibular advancement splints (MAS), or a mandibular protrusion device3, this type of device helps open the upper airway by moving the base of the tongue forward. This oral appliance is designed to be inserted before sleep, then removed in the morning.
MADs look similar to a mouthguard and can be customized to fit the individual4 or purchased in a stock form. These appliances come in multiple variations in terms of materials, shape, and color. Some are one-piece devices, while others have two separate pieces for the upper and lower teeth. The two-piece devices generally connect in some way, and some are adjustable in terms of how far they extend the jaw.
Research shows that MADs effectively treat OSA5. In addition to decreasing the number of lapses in breathing per night, these devices reduce snoring volume, snoring frequency, and daytime sleepiness. Generally, MADs do not monitor usage or symptoms, as CPAP machines do, but a “smart” MAD that monitors breathing6 and heart rate is in development.
A MAD can produce some side effects, though they usually aren’t serious. A person sleeping with a MAD device might initially find they produce extra saliva or experience dry mouth or gums. These symptoms generally pass with time, though some people experience more lasting symptoms, like pain and changes in how the teeth meet.
How Does Oral Appliance Therapy Work to Treat Sleep Apnea?
Oral appliance therapy treats sleep apnea by helping remove physical blockages from the upper airway. Mandibular advancement devices (MADs) help clear the airway by moving the jaw forward, while tongue-stabilizing devices (TSDs) help clear the airway by moving the tongue forward.
CPAP therapy is usually the first OSA treatment option offered to adults because of its 95% efficacy rate. However, oral appliances may be more effective in a real-world setting because some people are more likely to use them. CPAP only has a 40% compliance rate over the long term because some people cannot easily tolerate sleeping with a CPAP machine. However, mandibular advancement devices have an 80% compliance rate, and many people report preferring them over CPAP.
What Are the Risks of Oral Appliance Therapy for Sleep Apnea?
Using oral appliances to treat obstructive sleep apnea comes with little risk of harm. People who use oral appliances might experience some adverse effects, like discomfort or pain, dry mouth, excessive saliva, or adjustments in tooth placement.
Talking to Your Dentist About Oral Appliances for Sleep Apnea
Oral appliances might be a good option for you if you have been diagnosed with obstructive sleep apnea and have trouble using a CPAP machine. Instead of setting your CPAP aside and going untreated, talk to your dentist about the possibility of trying oral appliances, like a mandibular advancement device or tongue-retaining device.
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