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How Is a Dental Oral Appliance Used to Treat Sleep Apnea?
There are many treatments for obstructive sleep apnea available. Many doctors recommend continuous positive airway pressure as the preferred treatment option. However, some patients cannot tolerate CPAP machines or do not get adequate results from them, and patients with less severe apnea may not need such complex treatment. For these people, oral appliances can effectively reduce symptoms.
What are the two types of oral appliances for sleep apnea?
OSA occurs when the soft tissues of the throat and mouth, including the tongue, collapse in on themselves while the patient is sleeping, blocking the airway and causing the patient to stop breathing. Due to the blockage, the muscles of the chest and diaphragm must work harder than normal to clear the obstruction and resume normal breathing. A person with OSA can stop breathing hundreds of times during the night yet have no memory of it upon waking. There are two different types of oral appliances to treat OSA, but both work to keep the airway clear by controlling the position of the soft tissues surrounding it.
1. Tongue-retaining device
A tongue-retaining device is the less commonly used appliance. Made from polyvinyl, it has a bulb at the front for the tongue as well as parts that fit over the top and bottom teeth to hold the device in place. The patient pushes the tongue forward and creates suction by squeezing the bulb. This keeps the tongue in the desired position so it cannot fall back and obstruct the airway.
2. Mandibular advancement device
The throat and upper airway open up when the lower jaw, i.e., the mandible, is extended in a forward position. Therefore, the mandibular advancement device works by holding the lower jaw in an extended position while the patient sleeps. It consists of two pieces resembling mouthguards used in sports. One fits the lower jaw and one fits over the upper jaw.
Metal hinges attach the two pieces together, working to ease the lower jaw forward and hold it into position. Some mandibular advancement devices allow the patient to control the advancement to the desired degree. The MAD is the oral appliance used more often to treat sleep apnea.
How can a patient obtain an oral appliance for OSA?
Regardless of the type, the most effective OSA oral appliances are custom-fit to the patient's mouth. There are over-the-counter appliances available for sleep apnea, but these may not give good results. A medical doctor may diagnose OSA, then refer the patient to a dentist whose practice includes making custom oral appliances.
The dentist takes an impression of the patient's mouth, either digitally or using plaster. The impressions are used to make molds of the patient's teeth. These molds go to a laboratory where technicians make the appliance to fit exactly to the patient's teeth. When the appliance arrives from the lab, the patient makes a return trip to the dentist's office. The dentist shows the patient how to use and clean the appliance and makes any last-minute adjustments.
An oral appliance is an effective alternative for sleep apnea patients with mild to moderate symptoms or who cannot use a CPAP machine.
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