According to a study by the American Academy of Sleep Medicine (AASM), 29.4 million Americans are affected by obstructive sleep apnea–approximately 12 percent of the US adult population. For a good number of these people, an oral sleep apnea appliance is a great treatment—and one they will stick with. As a dentist, you can now play a part in the sleep apnea battle by fitting an oral appliance to your patient.
People with untreated sleep apnea have an increased risk of health complications including hypertension, diabetes, heart disease, and depression. Obstructive sleep apnea (OSA) is a sleep-related breathing disorder in which a person experiences an obstruction to the upper airway during sleep.
Common signs of sleep apnea include:
- Gasping or choking during sleep
- Snoring
- Fatigue or sleepiness while awake
- Impaired cognitive function
Dentists can check patients for signs of sleep apnea when performing an oral exam. Anatomical features such as a high-arched palate, large neck circumference, large tongue, large tonsils, or craniofacial structure can contribute to sleep apnea. If a patient’s partner or family member mentions that the patient chokes, gasps, snores loudly, or stops breathing during sleep, these may be signs of sleep apnea.
Patients with these symptoms should be referred to a primary care physician or a sleep medicine specialist for further examination.
If a doctor or specialist determines that a dental device is required, a qualified dentist will take a scan or impression of the patient’s mouth to make a sleep apnea oral appliance. That is then sent to a dental lab for custom device fabrication. When the appliance is completed, the patient returns to the dentist’s office for further adjustments.
Dentists who work collaboratively with a patient’s primary care physician and sleep physician provide the best care for their OSA patients.
Oral appliance therapy: Types of available sleep apnea oral appliances for treatment
Oral appliances are devices that help to reduce physical blockages of the airway. They are placed in the mouth to help keep the airway open while the patient sleeps.
Qualified dentists play a crucial role in:
- Evaluating patients for OSA
- Evaluating patients for the suitability of an OSA appliance
- Choosing and adjusting the best OSA appliance for the patient
- Follow up: Assessing patients for possible adverse effects of oral appliance use
Types of oral appliances for sleep apnea
Mandibular advancement device (MAD)
MAD is an oral appliance that keeps the mandible and the tongue in a protruded position, widening the upper respiratory tract. This prevents the patient’s airway from collapsing during sleep. A MAD is placed in the mouth before sleep. The appliance is removed when the patient wakes.
Nasal continuous positive airway pressure (nCPAP)
The CPAP appliance delivers a stream of compressed air to the patient via a hose attached to a nose mask. This keeps the airway open under air pressure so unobstructed breathing is achieved by reducing apneas and hypopneas.
The CPAP machine is turned on and the mask is placed on the nose before sleeping. When the patient wakes, the device is turned off and the nose mask is removed.
Tongue-Stabilizing Device (TSD)
A tongue-stabilizing device, often called a tongue-retaining device, uses suction to move the tongue forward during sleep to keep the tongue from blocking the airway. During use, the tip of the patient’s tongue protrudes through the lips. Research suggests that TSDs may reduce breathing lapses.
Rapid Maxillary Expansion (RME)
For children with OSA, rapid maxillary expansion (RME) is an orthodontic device that opens the airway by expanding the roof of the mouth. The child wears a custom-fitted expander, which is placed over the upper molars. The child wears the RME continuously. RMEs are designed to adjust the airway of children who have highly arched or narrow hard palates. Studies suggest that RME combined with surgery for tonsil removal or adenoid removal is more effective than RME treatment alone.
Mouth guards
Over-the-counter sleep guards are similar to mandibular advancement devices, they attempt to work by repositioning the lower jaw forward to keep the airway clear while the patient sleeps. Mouth guards are available without a prescription and sold in pharmacies or online. The patient immerses the mouth guard in a cup of boiling water for 60 seconds and firmly bites down on the softened plastic to create a custom-made impression. While these devices are the lowest barrier to entry, they run the inherent risk of the patient not creating a good bite in the mold they make at home.
Popular oral appliances for sleep apnea from Dandy
Dandy’s digital labs create custom 3-D printing sleep apnea devices that may best treat your patient.
Dorsal Fin Appliances
A dorsal sleep appliance is a two-piece appliance. The lower jaw is held in the correct position while allowing considerable jaw movement for the patient. The upper section has adjustable segments to control how much the lower jaw is advanced. The device has a dorsal fin that engages the maxillary and mandibular components and ensures the lower jaw stays in place during sleep.
Herbst Appliances
A Herbst appliance is another type of oral appliance used to treat sleep apnea. The Herbst appliance was invented in 1909 by Dr. Emil Herbst (1872–1940). It’s a mandibular repositioning device originally designed to correct Class II malocclusion. The device has been improved in recent years and is a popular choice for treating sleep apnea, bruxism, TMJ, and chronic snoring. Known for its flexibility, the Herbst appliance allows the patient to maintain their full range of motion, including movement from side to side.
Setting the patient up for success with an oral sleep apnea appliance
The oral appliance will only work for sleep apnea if the patient uses it, an obvious thought but one to always consider. While a patient won’t spit out a crown, it is important to make sure they adhere to the plan. A partnership between physicians and qualified dentists in sleep apnea treatment is essential. The physician will confirm the diagnosis and may recommend oral appliance therapy (OAT). The dentist will confirm that treatment is appropriate and begin patient therapy. Both the dentist and the physician perform follow-ups with each medical professional providing their unique expertise, ensuring thorough patient communication throughout enabling that they stick to the treatment.
Explore Dandy’s custom 3D-printed oral sleep apnea appliances to treat your patients.
