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Sleep Apnea Treatment with Oral Appliances

The protocol for treatment with an oral appliance is as follows:

A sleep knowledgeable physician, who decides that oral appliance therapy is indicated for a patient, refers the patient to a qualified dentist. He will provide a copy of the sleep study report requesting that an oral appliance be made. Alternatively a dentist refers to the physician for a diagnosis of a sleep breathing disorder. After the necessary tests, the physician will refer back to the qualified dentist for oral appliance therapy with a copy of the sleep study report. The dentist must do a thorough oral exam to make sure that the teeth and gums are healthy. Any major dental work should be done beforehand since large modifications cannot be made after the appliance is fabricated.

When informed consent is obtained and the dentist decides on the type of device to use, the device is fabricated. The device is then tested at home by the patient. If the device is adjustable, small adjustments are made to obtain optimum results based upon the patient’s symptoms. This process is called titration. When the patient feels that he or she is doing well with the device, the patient is sent back to the physician to see if it has successfully resolved the OSA by taking a follow-up PSG. If the physician feels that there could be more improvement, the patient is sent back to the dentist and the process repeats. Oral appliances are usually well tolerated after a few weeks. If the patient only has snoring and not OSA, follow up with the physician is not needed. Snoring is usually very easily treated with oral appliances.

Oral appliances can be used in severe cases where the patient can not tolerate CPAP. The appliance may not resolve the OSA but lessen the severity of it. If the OSA is found to be from primarily obesity, appliance therapy has been found to be less effective. Oral appliance can also be used in combination with CPAP, sometimes making the CPAP more easily tolerated. Oral appliances can also be taken away on trips much more easily than a CPAP machine.

Oral appliances do have some side effect such as bite and joint changes, which can usually be easily managed. They often take a few weeks to get used to. It is important that patients using oral appliances frequently follow up with their dentist to make sure that their symptoms and any side effects are managed.

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