Oral or dental appliances or devices may be considered a treatment option for obstructive sleep apnoea (OSA) patients who cannot tolerate CPAP therapy. Oral or dental appliances are termed mandibular advancement devices (MAD) or mandibular advancement splints (MAS).
Mandibular Advancement Device Explained
The oral appliance comprise of a mouth guard that is fitted to the bottom and top teeth and then joined in such a way that the bottom teeth is positioned in front of the top teeth. As the lower jaw is pushed slightly forward, the soft tissues and muscles of the upper airway are tightened thereby preventing obstruction of the airway during sleep. Opening up the airway reduces apnoea/hypopnea episodes during sleep and even lessen the severity of episodes. The tightening of the airway also prevents the upper airway tissues from vibrating during inhalation and exhalation which in turn prevents or minimizes snoring.
For most OSA patients, an 8mm to 10mm advancement is sufficient to make a difference. However, this is the not the rule-of-thumb as the MAD may have to be adjusted if the fit is not right. Pushing the bottom jaw forward could be quite uncomfortable a properly fitted MAD should not cause any grave discomfort. However, some tooth tenderness and excessive saliva production may be experienced by a user. Some OSA patients report that a MAD is more comfortable and convenient than a CPAP machine.
Is MAD for everyone?
Each OSA is different from each other is terms of the shape of their faces and airways. The success of a MAD is variable and assessment of the effectiveness of the treatment must be under the supervision of a qualified sleep specialist or dentist specializing in OSA oral appliances.
Who are good candidates for MAD?
• OSA patients with mild to moderate OSA. This refers to patients with 20 to 30 apnoea/hypopnea episodes during sleep.
• Those who suffer from positional apnoea/hyponea. This refers to patients who experience some relief from OSA when lying on his side.
• Those with a receding bottom jaw. The receding jaw could have caused the apnoea and pushing the bottom jaw out could effectively manage OSA.
Who are not good candidates for MAD?
The following are negative points for the treatment success of MAD.
• OSA patients with poor dental structure or those with no teeth as there is no structure to attach the device.
• Those with stiff jaw joints may not achieve the required 8 to 10mm advancement required for a MAD.
• Overweight OSA patients will fare better with CPAP machine.
• Those suffering from severe OSA. Though a MAD is capable of reducing apnoea/hypopnea by as much as 50%, this may not be enough for patients with hundreds of episodes during sleep.
• Patients with complicated sleep apnoeas such as central sleep apneas, MAD is not recommended.
Advantages and Disadvantages of Mandibular Advancement Device
Patients, with mild to moderate OSA, who used MAD, exhibited a significant reduction of apneas. People who sleep on their stomachs or backs showed marked improvement. Some reduction in the loudness and frequency of snoring were reported. MAD and other dental appliances such as Mandibular Advancement Splint (MAS) and Tongue Rotating Device (TRD) showed an adequate long-term control of sleep apnoea compared to surgical treatment such as uvulopalatopharyngoplasty (UPPP).
However, dental appliances have some disadvantages. A user is more likely to experience discomfort in the mouth, such as excessive saliva, tooth discomfort, dry lips and even pain. The side effects are mild and new oral devices are made of stronger yet pliable material.
Changes in the position of the jaw or teeth have been occurred in patients using an oral device for a long time. It is best to consult with a qualified sleep doctor and dentist when using a MAD.
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