As a practicing dentist I often receive phone calls and emails
from patients who want to know more about dental appliances that
eliminate snoring and obstructive sleep apnea. There is a lot
of information on the internet and in other media on this topic,
some accurate, some confusing, some misleading.
Dental appliances are a recognized treatment for both snoring
and mild to moderate obstructive sleep apnea, according to the
American Academy of Sleep Medicine. (See reference #1, end of
article).
The most studied and accepted type of dental appliance used to
treat these conditions is one that is worn in the mouth, bringing
the lower jaw into a more forward position (see reference
#2). A technical name for this type of appliance is a
“mandibular advancement appliance.”
Professionally made dental sleep appliances work on the
principal that if your lower jaw is brought forward, the base of
your tongue (at the back of your throat) will also be brought
forward, opening your airway during sleep and eliminating snoring
and obstructive sleep apnea.
Here is some information that will hopefully make it easier for
you to better understand the benefits and limitations of dental
appliances in the treatment of these two sleep disorders.
For patients with obstructive sleep apnea, the sleep clinic you
attended likely recommended a CPAP machine as the preferred way to
treat this condition and may not have even mentioned a dental
appliance as an alternative.
The big advantage that the CPAP machine has is that it is
effective for nearly all patients with mild, moderate and even
severe obstructive sleep apnea.
Dental sleep appliances can be very effective to eliminate
snoring and mild to moderate obstructive sleep apnea.
However, patients with severe OSA should not be treated with dental
sleep appliances as they generally won’t be effective enough to
treat this condition. Patients with severe OSA should try to
get used to their CPCP machine. If patients with severe OSA
refuse to use their CPAP machine, using a dental sleep
appliance could still be tried as it is considered to be
better than doing nothing.
The disadvantage of dental sleep appliances is that there are
some patients who may not get enough relief of their symptoms. The
reason for this is as follows:
- Their tongue may be wide and thick and occupy a large portion
of the back of the throat. When the tongue relaxes
during sleep in these patients there is too much tongue
volume filling up the airway, even if sleep appliance positions the
lower jaw as far forward as it will go.
- In overweight and obese patients there might be excess fat in
the walls of the tissues that line the throat and airway.
This constricts or narrows the airway and reduces the flow of air
to the lungs, the same way that stepping on a garden hose reduces
water flow. These patients will not be helped with a dental
appliance as it will not open the narrowed airway leading down to
the lungs.
- Patients with a receded lower jaw (or chin) may not be helped
by the dental sleep appliance. In these patients the lower
jaw and base of the tongue are positioned too far back, which can
close off the airway during sleep as the tongue relaxes. In
some of these patients, bringing the lower jaw and tongue as far
forward as they will go still may not be enough to open the airway
sufficiently.
There are other reasons difficult to predict as to why some
patients don’t get complete relief from dental sleep
appliances. So before a patient commits to spending money on
a permanent dental sleep appliance they could instead try a lower
cost temporary dental sleep appliance. If the temporary
appliance helps you can move on to a permanent appliance.
More on this later.
If CPAP will be effective for all cases of obstructive sleep
apnea and/or snoring why even consider a dental appliance?
- I will not go into the downside of CPAP in this article.
You may have already tried a CPAP machine and were not happy with
it or maybe you simply looked at the CPAP unit and decided right
away that it was not for you.
- Patients who are not tolerating the CPAP unit can go back to
their sleep physician to try to overcome issues they may have with
the using the CPAP.
- Dental sleep appliances are portable, convenient for travel,
and most would agree are less cumbersome to use than a CPAP.
- The only downside to dental sleep appliances is the uncertainty
regarding how well it will help you, and you won’t know for sure
until you try.
Are some types of dental sleep appliances better than
others?
There are many dental sleep appliances on the market that are
effective in treating snoring and mild to moderate sleep
apnea.
The appliance that I provide for my patients is called the
SUAD appliance. This appliance is approved by
Health Canada and the FDA (in the United States) for the treatment
of snoring and mild to moderate obstructive sleep apnea.
I have personally worn the SUAD appliance for several years now
to eliminate snoring.
As a dental consumer it would be difficult for you to decide
which dental appliance to try. They all basically do the same
thing: they bring your lower jaw forward, which brings the
back (or base) of your tongue forward during sleep, opening up your
airway. An extremely simple concept.
I would simply check that any appliance you consider
trying has the following features that the SUAD has:
1. Is the appliance approved by Health Canada and/or the
FDA for the treatment of snoring and obstructive sleep apnea?
2. Is the appliance comfortable to wear?
The SUAD has a soft inner material for comfort and a harder durable
outer coating for strength.
3. Does the appliance allow you to open and close your
mouth and move your lower jaw side to side while wearing it?
The SUAD does. Not all do. Some dental sleep appliances
keep your jaws closed together preventing you from opening or
moving your jaws side to side. What would you prefer?
4. Can the appliance be easily adjusted? The SUAD
has an extremely simple design and the amount or distance that it
brings your lower jaw forward can be easily adjusted by the patient
at home with absolutely no tools. Some appliances
are not adjustable. This is an important feature as the
distance the lower jaw is brought forward is crucial to
the success of the appliance. Some patients can tolerate
their jaw being brought more forward than others and it is nice to
have the ability and flexibility to fine tune the distance
rather than being confined to one setting.
5. Is the appliance durable and is it prone to
breakage? And does it have a warranty against breakage?
The SUAD appliance has a solid design and is warranteed (parts
and labour) for the first two years you use it. The SUAD
appliance should normally give many years of service. Check
on whether other appliances you may be considering have a warranty
and how long they can be expected to last. The SUAD
durability is its design. It is built solid and you can tell
just by looking at it.
6. Can your dentist provide a temporary, less expensive
sleep appliance that you can try out to see if you are a good
candidate for the permanent sleep appliance?
There is a Temporary SUAD
appliance that is an exact copy of the permanent
appliance except for the fact that it is made with mostly plastic
parts and may only last weeks or months as opposed to years..
This however is enough time to allow you to know whether a dental
sleep appliance is right for you. Fees for permanent
and temporary appliances are discussed below
Who is not a good candidate for a dental Sleep
appliance?
Patients who snore or who have mild to moderate sleep apnea can
be considered for these appliances but it is important you see your
family doctor before seeing your dentist. Your family doctor
will likely refer you to a sleep physician to get a proper
diagnosis before CPAP or a dental appliance can be considered.
If you have a history of pain and/or locking of your jaw joint
(TMJ) you may not be a good candidate for a jaw advancement
appliance we have been discussing.
If your teeth and gums are not in good health this will need to
be addressed prior to making a dental sleep appliance.
Patients who are missing all of their teeth in one or both jaws
can still be candidates for these appliances but may have to
consider dental implants to help hold the appliance in place.
What about do-it-yourself appliances for snoring that
are advertised on television or the internet?
All I will say about do-it-yourself appliances is you should
research whether they have the six features of the jaw
repositioning appliances such as the SUAD mentioned in this
article.
As well, if you are using a D-I-Y appliance can you be sure that
the condition of your teeth gums and jaw joints make you a suitable
candidate for a dental appliance?
If you do decide to have a dental sleep appliance made,
you should follow-up with your sleep physician to
determine if he/she would like to see you for a follow-up exam or
sleep study to ensure that the appliance is resolving the
obstructive sleep apnea. If it is, you will likely have
an idea even before you have your follow-up with the specialist,
for if the appliance is working well your snoring will be
eliminated and you will feel rested when you awake and throughout
the day.
If you would like further information on the SUAD appliance or
if you would like to book a free 15 minute consultation with
me you can call our office at 416-691-2886 or
email my receptionist at beachdentistry@gmail.com or
email me personally at dr.shnall@gmail.com
You can also click on the following link for further information
on this topic:
http://www.beachdentistry.com/snoringapnea-appliance
No one should have to live with obstructive sleep apnea.
You owe it to yourself to get treatment, whether it is a CPAP or
dental appliance.
Dr. Jeff Shnall ● tel
416-691-2886 ● 853 Kingston Rd, Toronto,
Ont. M4E 1R9
● Reception: beachdentistry@gmail.com
● my personal email: dr.shnall@gmail.com
References:
Note: the following two articles are and available online
(at the time of this writing).
Reference #1:
Clinical Guideline for the Evaluation, Management and Long-term
Care of Obstructive Sleep Apnea in Adults, Adult Obstructive
Sleep Apnea Task Force of the American Academy of Sleep Medicine,
Journal of Clinical Sleep Medicine, Vol.5, No. 3, 2009, page 271,
see section “oral appliances”)
Reference #2:
Management of Patients with Obstructive Sleep Apnea Robert
D. Ballard MD, Journal of Family Practise, Vol.57, No.
8 Suppl: s24-s30, Aug. 2008.
