Oral Appliance Therapy

Oral Appliances are placed in the mouth and are worn much like an orthodontic appliance or sports mouth protector. They are worn during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat so that the airway stays open during sleep. The appliances promote adequate air intake and help to provide normal sleep in people who snore and have sleep apnea.

Oral appliances can be used alone or in conjunction with other means of therapy such as continuous positive air pressure (CPAP). Determination of proper therapy can only be made by a collaborative consultation process between the dental and medical sleep specialists at the Snoring Centre.

Types of Oral Appliances

Currently, over 80 different types of dental devices for snoring and sleep apnea are available to specially trained dentists to treat sleep disordered breathing. At first glance, this number appears overwhelming but on close examination each of the appliances falls basically into one of two categories and the diverse variety is simply a variation of a few major themes. Oral appliances can be classified by mode of action or design variation.

Mandibular Repositioning Appliance

Mandibular repositioning appliances are by far the most numerous type on the market. They all function to reposition and maintain the lower jaw (mandible) in a protruded position during sleep. This serves to open the airway by indirectly pulling the tongue forward since the tongue is attached to the lower jaw, by stimulating activity of the muscles in the tongue and making it more rigid, and by holding the lower jaw and other structures in a stable position to prevent opening of the mouth. MRI tests confirm that inserting a Mandibular Advancing Device into a collapsed or collapsing airway, serves to dilate the airway preventing it from collapsing.

Thin shells are placed over the upper and lower teeth and a device is incorporated that will pull the lower jaw forward as necessary to open the airway.

Tongue Retaining Appliances

There are very 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.

How Oral Appliances Work

Oral appliances work in several ways:

• By repositioning the lower jaw, tongue, soft palate and uvula
• By stabilizing the lower jaw and tongue
• By increasing the muscle tone of the tongue
• By dilating the airway preventing collapse

By virtue of our education and training in oral appliance therapy, we are familiar with the various types and designs of appliances and can determine which one is best suited for your specific dental and medical conditions. Our office will work closely with you as part of the medical team in your diagnosis, treatment and on-going care.

Oral appliance therapy can take from several weeks to several months to complete, however , the improvements are most frequently noticed immediately. Even after the initial phase of treatment is complete, we will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.

Advantages of Oral Appliance Therapy

Oral appliance therapy has several advantages over other forms of therapy:

• Oral appliances are comfortable and easy to wear. Most people find that it only takes a couple of weeks to become acclimated to wearing the appliance.
• Oral appliances are small and convenient making them easy to carry when traveling.
• Treatment with oral appliances is reversible and non-invasive.

Appliances Used in Our Office

We use several oral appliances in our office depending on the size and shape of your mouth and tongue. Dr. Stern will discuss the advantages and disadvantages of each with you before making a final choice.

Klearway Appliance

Klearway™ is a fully-adjustable oral appliance used for the treatment or snoring and mild to moderate Obstructive Sleep Apnea. Fabricated of thermoactive acrylic, KlearwayTM becomes pliable for easy insertion and confirms securely to the dentition for an excellent fit while significantly decreasing soft tissue and tooth discomfort. Small increments of forward lower jaw advancement are initiated by the patient under the direction of a dentist and this helps avoid rapid jaw movements that can cause significant patient discomfort. Once warmed under hot water and inserted, the acrylic resin hardens as it cools to body temperature and firmly affixes itself to both arches. Lateral and vertical jaw movement is permitted which enables the patent to yawn, swallow, and drink water without dislodging the appliance.

THE KLEARWAY™ APPLIANCE FOR THE TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP APNEA

Silencer

The Silencer Professional is a laboratory fabricated fully adjustable oral appliance for the treatment of sleep apnea and snoring. The appliance features a titanium precision attachment, which controls the anatomical settings of the appliance. It is capable of anteroposterior adjustment as well as vertical adjustment through a range of 10mm, in both dimensions. The design of the precision attachment also allows lateral movement of the mandible which respects and protects the TMJ. The titanium Halstrom Hinge(r) is made of implant grade titanium and carries a five-year warranty.

There are three component materials in the Silencer. The body of the appliance is constructed of elastamer,a pliable material which offers the patient a much greater degree of comfort than harder acrylic materials. For additional support, to the dentition as well as the temporomandibular joint, hard acrylic bite pads are placed in the molar regions. A commercially pure titanium articulating component grants the appliance the many adjustment characteristics that make the Silencer unique - kind to the tissues, the teeth, and the temporomandibular joint.

FDA Approval: Approved for both snoring and OSA
Date of FDA Approval: Nov 29, 1995
FDA Registration Number: K954530

What To Expect

Treating snoring and sleep apnea requires a team approach. The first step, then, in being treated for snoring or obstructive sleep apnea is to obtain an evaluation by a sleep physician who will provide a formal diagnosis usually based on a medical sleep study that will be organized by the staff at The Snoring Centre. The Snoring Centre is on the cutting edge of offering home sleep studies, potentially avoiding the need for a traditional overnight study.

After that, in consultation with your sleep physician, it will be determined whether you are a good candidate for oral appliance therapy .

The first dental appointment will involve a discussion of the problem, the advantages and limitations of oral appliance therapy in your case, an oral examination including an x-ray of your teeth . Side effects and contraindications will be fully disclosed and discussed.

Impressions will be taken for the appliance.

After the selected appliance is fabricated, you will return for a second appointment for a custom-fitting and instructions on use and care of the oral appliance. After that you will return for approximately two more times for follow-up visits to monitor the effect of the appliance and to make any necessary adjustments. The effectiveness will judged by resolution of your subjective symptoms (snoring and daytime sleepiness) and a second sleep study need may be discussed.

When the snoring and tiredness have been resolved and you show good improvement, you will be referred back to your sleep physician for final evaluation. Sometimes it will involve another sleep study.

Ultimately, our office will follow your progress on a twice per year basis to ensure adequate treatment and to monitor any possible side effects.

Monitoring Progress

Like CPAP, oral appliance therapy for snoring and sleep apnea is not a cure. The dental device must be worn every night for it to be effective. Your progress with the oral appliance should be monitored over time to ensure that the appliance continues to do its job in providing relief of snoring and sleep apnea and to ensure that you remain symptom free.

The doctor will carefully follow and guide your progress throughout your treatment. You will be seen in the office several times to ensure acceptance, comfort and effectiveness of the therapy. Instructions will be given on proper adjustment of the appliance and any areas of discomfort will be addressed. The objective will be to resolve the snoring and daytime tiredness through gently and gradually repositioning the lower jaw. Your personal feedback, and possibly , sleep studies, will provide guidance.

Once active therapy is completed you will be reevaluated on a six month or one year visit depending on your individual case

Care of Oral Appliances

Oral appliances are easy to care for but they do have to be cleaned regularly.

Each morning, simply brush it with a toothbrush and toothpaste. Rinse it well and allow it to sit in its case all day with the top open. Be sure it is up, out of the way, where no curious dogs can chew on it! Also avoid extremes of temperature, especially heat, since the appliance may distort. Do not leave the appliance in direct sunlight.

Examine your appliance frequently and call the office if you observe any broken areas.

Exercises

Some patients may find that their bite feels off a bit ,in the morning immediately after removing the appliance. This is normal and is due to a temporary jaw joint change. This will generally resolve within minutes on its own as the joint drifts back into its normal position.

Jaw exercises are helpful to re-establish joint position and good tooth contact. This can be accomplished by clenching the teeth together and holding for several seconds and then releasing and then repeating the clench/release for a minute or so. Or, you may clench/release on the soft plastic exercise tabs that were provided to you.

Another method is to chew gum while taking a hot shower. Chew and shower for about 10 minutes or until teeth close properly and comfortably.

Side Effects

Most of the side effects encountered during appliance use are minor and temporary. They include slight tenderness to teeth, muscles and joint. Dry mouth and increased salivation are also noticed. In addition, teeth may not meet properly for few minutes after first removing the appliance after a nights use. The office will work with you to manage these occurrences and minimize any problems.

It should be noted that in some patients, a permanent bite change may occur over the years due to a small, permanent change in jaw joint position and/or minor tooth movements due to the pressures placed by the appliance each night. In most cases these changes are slight and usually not even noticeable to the patient.

It is important to keep up with twice yearly evaluation visits allowing the doctor to monitor any possible changes in your bite. They are most easily managed if discovered in the early stages.