Dental Sleep Appliances
Have you been referred to Dr Lim by your sleep physician?
Click here to download Your Guide to Oral Appliance Therapy
Custom made dental sleep appliances, commonly referred to as Mandibular Advancement Splints reposition the tongue and lower jaw forward to maintain an open airway. Dentists trained in dental sleep medicine know how to select, fabricate, fit and adjust these devices, which look like sports mouth guards, to help patients breathe freely during sleep.
How do they work?
Oral appliances help prevent collapse of the tongue and soft tissues in the back of the throat, keeping the airway open during sleep and promoting adequate oxygen intake. They work in several ways:
Repositioning the lower jaw, tongue, soft palate and uvula
Stabilising the lower jaw and tongue
Increasing the muscle tone of the tongue
This video features an animation that shows how an oral appliance can prevent the tongue from obstructing the airway and describes the different ways these appliances can open the airway.
Who are dental sleep appliances suitable for?
Oral appliances are well suited for
People with a diagnosis of primary snoring or upper airways resistance syndrome
People with a diagnosis of mild to moderate Obstructive Sleep Apnoea (OSA) who prefer it to Continuous Positive Airway Pressure (CPAP) or unable to use positional therapy or weight loss to control their apnoea
People with a diagnosis of severe OSA if they can not tolerate CPAP therapy.
Patients with severe OSA should always trial CPAP before considering oral appliance therapy.
A diagnosis of primary snoring or obstructive sleep apnoea must be made by a sleep physician. A dentist trained in dental sleep medicine can then provide treatment with oral appliance therapy.
Dental sleep appliances for primary snoring
Custom made dental sleep appliances are the most widely proven treatment option in the management of snoring. They are recognised by the American Academy of Dental Sleep Medicine as a front line treatment option for the management of primary snoring.
How does an oral appliance for OSA work compared to Continuous Positive Airway Pressure?
CPAP is recognised as the gold standard of obstructive sleep apnoea because at the right air pressure, the effect is immediate and it can potentially eliminate all obstructive events. However it has been estimated that 25-50% of people are unable tolerate CPAP.
In contrast dental sleep appliances involve a period of acclimatisation, follow up and adjustment to work optimally. Whilst highly effective at reducing snoring, they may not reduce obstructive events to the same degree.
Studies do show that they can be equal in improving quality of life measures. A large part of this is due to the fact that patients tend to find dental appliances more comfortable and tend wear them for longer periods during the night compared to hours of CPAP use.
The benefits of oral appliance therapy over CPAP include:
Ease of use - Some patients prefer oral appliances because they can be easy to wear. For most patients it takes a few weeks to get used to sleeping with an oral appliance in your mouth.
Small and easy to transport – Traveling with your sleep apnoea treatment is easy with an oral appliance therapy. Unlike CPAP, oral appliances are small enough to fit in your purse or carry-on bag, and are suitable for situations like camping when there is no electricity.
Treatment with oral appliances is reversible and non-invasive.
How do custom made appliances compare to appliances from the Internet or Pharmacist?
A number of cheaper appliances are available for purchase over the counter or from the internet. These can not be reccomended. It is very important that the device that you are going to use for a long period of time to treat a serious medical problem is properly manufactured, fitted and working for you. For patients with more than just snoring, proving that it works may require a sleep study to be repeated. Appropriate long-term follow up with your dentist or sleep specialist is also strongly reccomended.
Such appliances can be bulky and more difficult to continue wearing. Lack of success with one of these appliances in the past does not predict success with a custom made device.
Possible side effects of dental sleep appliances.
Oral appliance therapy may cause frequent but minor side effects. These include excessive salivation, dry mouth, tooth and jaw discomfort and temporary bite changes. Most of these side effects are minor and resolve quickly on their own or with minor adjustment to the appliance.
Some patients experience potential complications such as jaw pain, permanent bite changes and TMJ symptoms. These complications can be recognized and managed by dentists trained in dental sleep medicine.
Predicting success with dental sleep appliances
As with all teratments, some people respond better than others. There are several indicators that treatment may not be as successful and there are other factors that are predictors of treatment success. A dentist specially trained in Dental Sleep Medicine is well suited to assess your chances of success and advise you if this treatment is not suitable.
Determining suitability for oral appliance therapy
If you are interested in investigating whether a dental sleep appliance for snoring or obstructive sleep apnoea is for you, please contact us to organise a consultation with Dr Lim.