Not so long ago we spoke about CPAP?machines. These machines have been used pervasively as part of therapies for sleep apnea?through the use of continuous positive airway pressure. Not everyone is very enamored with these machines however and as a result the hunt?for alternatives has been on for a very long time. One of these alternatives is actually taken from the dental practice. The name of said intervention is an “oral appliance”, that is, an apparatus specifically targeted at sleep apnea by altering a feature (or features) of one’s dental characteristics. Sleep dentists normally verify a range of factors in their investigations: the size and tone of one’s tongue?as well as features of the palate and teeth in order to verify a candidate’s suitability for this type of therapy.
An oral appliance is basically a fixture that fits within the mouth, resembling the typical mouth guard used in boxing. Though they may look alike, the functions are quite different. The purpose of the oral appliance is not to protect the teeth but rather to help prevent the tongue and soft tissues at the back of the throat from obstructing the airway. As we’ve seen before, a?constricted airway can lead to a lot of bad things! The purpose of the oral appliance is pretty simple, since we have ?no pumps involved to force the airway to remain open, either provide more room, and/or stop the collapse.
Types of Oral Appliances
There are two types of oral appliances, the first (and more popular) being mandibular advancement devices (MADs) and the?second being tongue stabilizing/retaining?devices (TSDs).?They both accomplish their primary function in slightly different ways. MADs?pull the jaw forward so as to ensure that the tongue and the rest of the soft palate do not fall backwards into the airway.
TSDs, on the other hand,?serve to pull the tongue forward in the mouth only, without influencing the position of the jaw. Either way, the overall room within the mouth?and airway?is increased which means (voila!) better sleep. This is sometimes preferred by certain users since there isn’t much influence on the teeth and jaw.
?Benefits of Oral Appliances
So…with everything that’s been said about CPAP, why would you ever need an oral device??This is where the science gets interesting. Studies have shown that oral appliances yield very similar results in the medium-to-long-term as the application of CPAP for persons with mild to moderate sleep apnea! This therefore means not those who either cannot tolerate the pressures introduced by CPAP,?or find long-term compliance with CPAP to be very difficult, definitely have other?alternatives. There are also two primary benefits that accrue to users of oral appliances:
- Mobility – It is much easier to get around with an oral appliance than it is with a larger device?such as a CPAP machine. Can you imagine having to go on a plane, especially for a long flight with possibly multiple connections, and having to carry a CPAP machine all that way? It makes a very big difference if you can simply pop in?your oral appliance once you’ve settled in?so as?to get a comfortable and good quality sleep. For many persons this is one of the most important attributes of an oral appliance–the fact that you can take it anywhere and use it almost virtually any time.
- Portability – Let’s say that moving your CPAP around wasn’t an issue (and indeed some of them come with travel bags!) What would you do about power? The other great thing about?oral appliances is the fact that one?does not need a power supply, or batteries in order to work! CPAP machines nowadays?may very well have?portable battery packs, or even a range of power options, but bottom line is they still do need to have a power source in order to function and as such are not extremely?portable.
Note that this does not mean that the two interventions cannot be combined as a form of holistic therapy. It is actually recommended that one’s sleep dentist, ENT specialist and any other physicians providing care centering on sleep issues work together in order to arrive at the best solution for the patient. There are solutions that utilize custom fit devices combining oral?appliances and CPAP machines. These generally consist of the oral?device?and a customized mask usually with nasal pillows that are built to fit the patient’s facial profile. In essence therefore it is important to recall that none of these therapies are really?one-size-fits-all–it is best to work with your doctor to come up with a solution that is right for you.
Caveats and Downsides of Oral Appliances
Let’s reverse our previous query then…why bother to use CPAP at all? To cut to the point, there are no easy answers to that, it all depends on the specific case of the user and the recommendation of attending physicians. Idiosyncrasies and personal preferences also lay a role here…for example my wife loves her teeth and would certainly would not want to be fitted with an MAD! Nevertheless, despite the answer being case-dependent, there are a few general caveats for use that must be considered. For TSDs,?is is usually best to ensure that you are not an exclusive mouth breather or have been diagnosed with severe sleep apnea. For MAD’s, loose teeth and dentures are usually no-nos, and sufferers of temporomandibular joint disorders (TMDs)?should preferably avoid using?these devices. We’ll talk more about this in the upcoming section.
The downsides of oral appliances may be of some inconvenience but they are primarily short-term issues. Some persons complain of the below but resolution (normally) occurs within a few months. Naturally, there should be?consistent follow up with one’s sleep dentist so that progress can be monitored. Here are five (5) discomforts you should expect when using oral appliances. Note that most of these are associated with using MADs rather than TSDs.
- Hypersalivation – The natural reflex for putting something in one’s mouth is for the salivary glands to produce…well…saliva. Having either kind of?oral appliance?in place, especially for several hours at a time, will naturally stimulate this reaction. Ultimately, this is not a big deal and usually?resolves itself within a few weeks of use. A little drool never hurt noone!
- Throat dryness – Since the airway is being held open for longer periods it is sometimes very natural for one to have a dry or tickly throat at the end of a sleep session. Once more, this is a minor inconvenience that?may occur from time to time, particularly in cases where the air is dry or cold. Use of a humidifier can assist here!
- Painful chewing?- Within the first couple weeks to a few months of starting treatment using an MAD, it is very likely that in the mornings eating may be difficult. This is due?to the stress caused by using the device on the teeth and on the gums. As you get used to the device this pain will decrease but, until then, it may be good to stick with softer foods that are easier to handle. Stay away from those apples!
- Bite changes?- The forces exerted on the teeth and jaw especially by MADs will usually change one’s bite pattern over a long period of time. It is definitely a good idea to ensure that frequent follow-ups are done with one’s?sleep dentist, just to make sure that the device it’s still fitting comfortably in accordance with one’s?own physiological peculiarities.
- Temporomandibular joint (TMJ) pain?- Users of oral appliances (once more, with greater reference here to MADs) can sometimes develop pain of the temporomandibular joint. This joint serves to hinge your jaw?to the rest of your skull and , in?conjunction with your jaw muscles, facilitates activities such as biting, chewing, talking etc. Since MADs usually exert a forward pull on the lower jaw, it is possible for the joint and associated muscles to become painfully stressed.?In cases where persons are already afflicted with TMDs,?it makes sense to avoid this type of treatment.
Accessing Oral Appliances
Oral appliances can be accessed over the counter and are pretty easy to find online. MADs in this category?are usually of the “boil-and-bite” variety, being made of thermoplastic that becomes malleable after boiling for a short period. TSDs are however normally one size so these may be a bit harder to guarantee in terms of fit. As in all cases, seeing a sleep dentist is a great first option to ensure that any custom requirements are sorted out in advance.
Are you a present sufferer of sleep apnea, thinking about employing a specific type of therapy? How about a present user of an oral appliance? I do hope you found this information useful, and of course please drop me a line below if you have any comments or queries!