What is OAT - Oral Appliance Therapy ?
Oral Appliance Therapy refers to the use of a dental appliance, similar to an orthodontic retainer or an athletic mouthguard, which is worn in the mouth during sleep to prevent the soft tissues of the throat from collapsing and obstructing the airway. Dentists with special training in Snoring, Obstructive Sleep Apnea (OSA) and Oral Appliance Therapy will carefully select, design, construct, and fit these special appliances to meet the specific anatomical, physiological and comfort needs of the sleep apnea patient. In recent clinical studies, physicians and dentists have shown that, in a majority of apnea patients, a properly selected, well-designed, well-fitted oral appliance can effectively reduce and sometimes even eliminate snoring, and significantly relieve symptoms of mild to moderate OSA.
Indications for Oral Appliance Therapy
The American Academy of Sleep Medicine (AASM) has stated that oral appliances are indicated as a first treatment of choice for patients with primary heavy snoring and/or mild obstructive sleep apnea and as a treatment option for patients with moderate or severe sleep apnea who cannot tolerate CPAP and/or are not good candidates for surgery. Oral Appliance Therapy can also be useful in combination with CPAP when there are compliance issues with nasal CPAP alone, e.g. the treatment pressures can usually be lowered and made more tolerable.
Effectiveness of Oral Appliances
Research evidence shows that oral appliances are effective in treating snoring in 85-90% of the patients. The mandibular advancement devices are effective in normalizing the apnea levels in 75% of the patients with mild sleep apnea (5-20 events/hr.), 60% effective for patients with moderate sleep apnea (20-40- events/hr.) and 40% effective for patients with severe sleep apnea (more than 40 events/hr.). Patients with moderate or severe sleep apnea must have a follow-up sleep study while using the oral appliance to confirm the effectiveness of the device and a consultation with the sleep medicine physician to discuss the results.
Possible Side Effects of Oral Appliance Therapy
There are a number of temporary side effects that may be noticeable during the first few weeks or may require minor adjustment of the appliance by the dentist. These include: jaw tension, sore gums, excessive salivation, temporary bite changes, joint noises or pain, teeth movements, loosening of dental restorations. From the research evidence and our clinical experience, jaw muscle and joint pain occur in approximately 10% of the patients and the pain will disappear when the patient discontinues use of the appliance. However, the pain can recur for these patients when they start wearing the appliance again. Changes in the bite can occur for about 20% of the patients. Although the changes may be slight it may still be difficult for the patient to close their back teeth together and this may have an effect on their ability to chew effectively. The slight movement of teeth and loosening of dental restorations occurs very infrequently (1-2% of the patients).
TYPES OF ORAL APPLIANCE THERAPY
Oral Appliance Therapy works in three different ways with three types of appliances:
1.Mandibular Advancement Appliances (MMA) - by advancing the lower jaw forward and opening up the airway space.
2.Tongue-Retaining Devices (TRD) - by holding the tongue forward and opening up the airway space
3.Palatal Lifting Appliances (PLA) - by lifting a drooping soft palate and opening up the airway space.
Sometimes, A Combination Appliance - CPAP/PRO is necessary.
The sleep apnea dentist will examine your entire oral areas - intra and extra oral structures - including your teeth, occlusion, jaw joints, etc. to determine which appliance is best for you.
The proper selection, design, fitting and alignment of the sleep apnea appliance is crucial and must be followed up with a sleep study to ensure that it is working properly.