Oral Appliances are similar to an orthodontic appliance or sports mouth protector, but are worn during sleep and are specifically designed to provide adequate air intake and normal sleep in people who snore and have a medical condition known as obstructive sleep apnea.
Custom sleep apnea appliances must be fitted by a dentists specifically trained in oral appliance therapy, dental occlusion and treatment of temporomandibular joint (TMJ) disorder.
A sleep study must first be performed in order to diagnose obstructive sleep apnea, to ensure other sleep disorders are not at play and to evaluate the effectiveness of oral appliance therapy. Treating just snoring with a custom oral appliance or snoring mouth guard can dangerously mask or worsen sleep apnea, even if snoring has stopped or significantly reduced.
After impressions of your teeth are taken, a custom oral appliance will be fabricated. This usually takes 2 or 3 weeks. Your dentist will fit your appliance and will review instructions of use. Your dentist will guide your treatment and adjust the oral appliance until the snoring, excessive sleepiness or any other sleep apnea related symptoms have been reduced or eliminated. The effectiveness of the oral appliance is then verified by measuring your apnea-hypopnea index (AHI) during a follow-up sleep study.
Oral appliances, also known as mandibular advancement devices, are custom fit devices that are worn only at night that fit much like a sports mouth guard. It supports the jaw in a forward position and is designed to help maintain an open airway.
Oral appliances can be used alone or in conjunction with other means of therapy such as continuous positive air pressure (CPAP), positional therapy or surgery to reduce snoring and treat obstructive sleep apnea by preventing the airway from collapsing.
If you have ever witnessed an apneic event first hand, you know it can be frightening to see a friend or loved one struggling to breathe while sleeping, and then gasping for air as if they are suffocating. Apneic events in patients with obstructive sleep apnea are caused by the tongue and soft tissues in the back of the throat collapsing, causing "a cessation of airflow for 10 seconds or more”. An apneic’s bed partner may be relieved and try to fall asleep when the apneic briefly stops snoring, not realizing that those coveted moments of silence actually mean the person they are sleeping next to isn’t breathing.
There are over 100 custom oral appliances approved by the FDA. These appliances fall into two types of oral appliances for the treatment of obstructive sleep apnea.
Mandibular advancement splints are by far the most numerous type on the market. They all function to reposition and maintain the lower jaw (mandible) forward in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward.
There are only a few tongue retaining devices available, but they have been well studied and shown to be effective in many patients. Tongue retainers function by directly holding the tongue in a forward position by means of a suction bulb that holds the tongue. When the tongue is in a forward position, the back of the tongue does not collapse during sleep and obstruct the airway in the throat.
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Custom dental appliances for sleep apnea are covered by most medical insurance companies and Medicare.