Oral Appliances For Snoring and Sleep Apnea

Non-Surgical Treatment Tool For Snoring and Sleep Apnea: Dental Appliance

Snoring prostheses are sold in the mouth and in the nose. Snoring prostheses, also known as "intraoral" apparatus or dental appliance, are generally considered in two groups as those pulling the tongue forward and lowering the lower jaw. It can be considered as another option especially for those who are overweight who cannot lose weight and who have not achieved successful treatment with nose and other snoring operations.

Claustrophobic patients who receive continuous positive airway pressure (CPAP) treatment due to sleep apnea may not be able to use CPAP (CPAP intolerance). In the same way, snoring apparatus can be used as a non-surgical adjunctive treatment tool in patients who cannot be operated considering the risks of surgery and anesthesia.

How Do Oral Appliances Work?

Oral appliances function in two different ways: repositioning the lower jaw and / or pulling the tongue forward. Mandibular advancement devices (MAD) keep the lower jaw in front during sleep. In this way, they keep the airway open by preventing soft tissues such as the throat and tongue root to collapse backwards. Tongue retraining devices (TRD) function by blocking the airway during sleep, preventing the back of the tongue from falling backwards (source link >>  Oral Appliances).

I am adding different orall appliance device animation videos on the below:

Sleep Apnea treatment with a Dental Appliance

Snoring, OSA and Treatment with a Mandibular Advancement Device Animation

Snoring & Sleep Apnoea - Sleepwell Mandibular Advancement Splint

Oventus O2Vent Animation - how the device works

Indications of Oral Appliances

These oral devices (snoring prostheses) are indicated for the following patients:

• Simple snoring problems
• Upper respiratory resistance syndrome (UARS)
• Mild, moderate or severe obstructive sleep apnea (OSA)

These devices can be used alone or in combination with Continuous Positive Airway Pressure (CPAP) or surgery.

The American Academy of Sleep Medicine (www.aasmnet.org) recommends these products to patients with mild to moderate severe sleep obstructive apnea syndrome and not suitable for CPAP treatment.

Contraindications For The Oral Appliances

Patients should not receive oral device therapy (snoring prosthesis treatment) if:

• No teeth in the mouth
• Limited number of teeth (consult dentist)
• Active dental diseases
• Minimum opening opening
• Children
• Symptoms of acute temporomandibular joint dysfunction (TMJD)
• TMJD arthritis (inflammation of the jaw joint)
• Significant psychological avoidance of contact with structures within the oral cavity
• Moderately limited dexterity or inadequate skills for use of the device
• Limited mental capacity (source link >>  Oral Appliances in Snoring and Obstructive Sleep Apnea)

Advantages of Oral Appliances

• Easily accessible
• Does not carry the risk of surgical procedures
• Practically usable

Oral appliances are a non-invasive alternative therapeutic tool for the treatment of snoring and sleep apnea. Compared to CPAP, they had a higher compliance rate and were less laborious (but treatment success unfortunately is not the same ...).

Disadvantages of Oral Appliances

• Intraoral anatomy and jaw joint should be normal for the use of an intraoral apparatus
• Foreign body in mouth and jaw displacement may not be tolerated easily by all patients
• More limited effects on sleep apnea treatment alone in patients with nasal obstruction
• Provides temporary airway-wide expansion only during sleep as there is no permanent effect on surgical procedures
• There are studies showing that no increase in blood oxygen levels and apnea hypone index cannot be achieved with CPAP treatment with these snoring prostheses (source >>  Effectiveness of an anti-snoring prosthesis in obstructive sleep apnea syndrome).
• Salivary changes in the mouth and salivation due to open mouth may cause dryness; dental caries and oral hygiene
• In patients with severe sleep apnea, its effectiveness is much less than in sleep-induced pressurized oxygen therapy (CPAP therapy). In a study called Effectivity of an anto-snoring prothesis in obstructive sleep apnoea syndrome snoring prostheses were compared with CPAP treatment, it was found that only a small number of patients with sleep apnea could decrease blood oxygen values ​​and decrease disease severity.

Complaints such as night pain, dry lips, tooth discomfort and excessive saliva production are common. Permanent changes in the tooth or jaw position can occur for long-term use (source link >>  Obstructive Sleep Apnea Dental Devices).

More than 100 different names from intraoral apparatuses sold as snoring prostheses are commercially available.

Occupational accidents and traffic accidents are more common in patients with sleep apnea, snoring and sleep disorders!

Since sleep apnea, snoring and sleep disorders are now scientifically proven to be associated with occupational accidents and traffic accidents, it is thought that the treatment of these health problems can prevent many financially damaged work and traffic accidents. In addition, sleep apnea and snoring are a health problem that needs to be treated early because of early deterioration of cardiovascular health and early hypertension treatment and cardiologic examinations. Link to source topic >> Apnea and Accident Rate

The latest report on global road safety by WHO (World Health Organization - WHO) describes traffic accidents as a priority public health issue. In this report, it is emphasized that patients with sleep apnea and snoring should be treated by emphasizing the causes of traffic accidents and the economic and social consequences of accidents (Source link >>  Global status report on road safety). In the same report, visual or hearing defects such as sleep disorders, rheumatic heart disease, diabetes, neurological diseases, alcoholism, drug use or mental illness are highlighted as other common causes of traffic accidents. According to recent publications, the risk of traffic accidents in sleep apnea, snoring and other sleep disorders has been shown to increase more than twice (up to 6-12 times in some publications).

There is almost no tissue in our body that this syndrome affects! Repeated release of oxygen and stress hormones causes these damages.

Nightmare can be seen frequently in obstructive sleep apnea syndrome!

In patients with sleep apnea syndrome, during nighttime blockage attacks, symptoms such as decrease in blood oxygen levels and increase in stress hormones, rapid rise in blood sugar level and rapid fall can be added to metabolic effects such as nightmares, waking from sleep with fear of death, waking from sleep with feeling of suffocation. These symptoms may increase as the amount of obstruction increases.

Who can use the snoring prosthesis?

For the treatment of snoring, snoring prostheses that open the airways produced for the mouth and nose can be used in patients who are unsuitable for surgery or who do not accept surgical treatment. Patients with snoring problems and suitable for snoring prosthesis:

Pregnant patientsAnd elderly patients who are not suitable for surgery, patients with serious systemic disease or blood thinning medication where surgery is risky patients who do not accept surgical treatment.

Who is not suitable for snoring prostheses?

Snoring prostheses are not suitable for the following patient groups:

Pediatric patientsIn the mouth, patients with no tooth structure to hold the apparatus (may use different products that draw the tongue) Active dental disease (in this case only the recommended apparatus for the nose can be used) Orthopedic disease or acute infection in the jaw joint mental retardation Most of the above are contraindications to the oral apparatus. There are many different products for snoring apparatus and nose openers and throat airways. Snoring prostheses, known only as intraoral apparatuses, can be roughly divided into 3 groups:

1. soft palate lifters (SPL)
2. tongue retaining devices (TRD)
3. mandibular advancement appliances (MAA)

Side effects of snoring prostheses

Side effects of the intraoral apparatus, which are frequently used as a snoring prosthesis, can be listed as follows:

• chewing difficulty
• excessive saliva production
• dry mouth
• dental disorders
• language disorders
• jaw pain
• headache
• TMJ (jaw joint) pain and diseases
• masseter muscle pain

Similar links >> Treatment of Snoring and Sleep Apnea / Obstructive Sleep Apnea Syndrome and Snoring

Murat Enoz, MD, Otorhinolaryngology, Head and Neck Surgeon - ENT Doctor in Istanbul

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