When is the use of intraoral appliances to treat snoring and obstructive sleep apnea indicated?
The use of intraoral appliances is indicated in cases of:
• Patients with snoring, or patients with mild or moderate obstructive sleep apnea who do not respond to treatment using general practices, such as weight loss, sleep posture modification etc.
• Patients with high severity obstructive sleep apnea who have tried using treatment with CPAP but cannot tolerate it.
• Together with CPAP, in patients suffering from very severe obstructive sleep apnea. The combined use of CPAP and intraoral appliance requires lower pressure of air to be blown from the CPAP device in order for the patient to breathe normally, making the treatment more tolerable and effective.
In 2006, the American Academy of Sleep Medicine, after assessing the results of long-term clinical studies, issued a clinical guideline according to which intraoral appliances should be the first line treatment for snoring and of mild to moderate obstructive sleep apnea. This is due to the proven efficacy of intraoral appliances in combination with their ease of use and acceptance by patients.
How do the intraoral appliances for the treatment of snoring and obstructive sleep apnea work?
The intraoral appliances place and stabilize the lower jaw, the tongue, the uvula and the soft palate at suitable positions so as not to prevent the flow of air, allowing the patient to breathe comfortably and naturally during sleep. There are many types of intraoral appliances. A dentist that deals with the treatment of snoring and obstructive sleep apnea will assess the anatomical features of the oral cavity and select the intraoral appliance most appropriate for each patient.
What are the advantages of using intraoral appliances for treating snoring and obstructive sleep apnea;
• Intraoral appliances are comfortable and easy to install and use.
• Treatment with intraoral appliances is non-invasive and very effective.
• Apart from snoring and apnea, intraoral appliances also treat bruxism, which is the clenching and grinding of teeth during sleep. Bruxism can cause serious damage to the teeth, as well as pain in the muscles and joints of the mouth. Recent studies have shown a correlation between bruxism and obstructive sleep apnea.
• The compliance of patients to treatment with intraoral appliances is very positive. The rate of long-term use of intraoral appliances is higher than of other treatment options.
• Intraoral appliances have small size, thus they are easier to transport and used by patients who travel frequently.
How safe is the use of intraoral appliances for the treatment of snoring and obstructive sleep apnea?
Intraoral devices are completely safe for the majority of patients who snore or suffer from obstructive sleep apnea. There are some exceptions, such as patients who experience pain and dysfunction of temporomandibular joints (joints of the lower jaw). This happens because most intraoral appliances move the lower jaw to widen the airway, which can exacerbate the pain and discomfort these patients feel. In such cases, the dysfunction must be managed by the dentist, before the intraoral appliance is delivered.
Moreover, in cases where the application of the intraoral appliance causes the mandible to move outside of the tolerance limits of the temporomandibular joints, iatrogenically induced pain and dysfunction may appear. A dentist specialized in treating sleep disorders uses specific technological equipment, and through appropriate clinical examination assesses the health and function of temporomandibular joint structures and constructs the intraoral device in such a way in order to avoid this type of problems.
For the above reasons, one should be careful with over the counter intraoral devices sold freely and without medical supervision, which are adapted to the mouth by the patients themselves. The health risks due to damage and pain in the jaw joints by far outweigh the advantages of such devices, i.e. their low cost.