An oral appliance is a small acrylic device that fits over the upper and lower teeth or tongue (similar to an orthodontic retainer or mouth guard). This device slightly advances the lower jaw or tongue, which moves the base of the tongue forward and opens the airway. This improves breathing and reduces snoring and apnea. The appliance is fabricated and customized for each patient by a dentist experienced in the treatment of snoring and sleep apnea. The appliances are comfortable and well tolerated by the patients. They are easy to place and remove, easy to clean and are convenient for travel.
The two main categories of oral appliances currently in use are the mandibular
advancement devices (MAD) and the tongue retaining devices (TRD).
The mandibular advancement devices are custom-made for each patient. The device is made of a special heat-sensitive acrylic material that will fit snugly, but comfortably over the upper and lower teeth and it will hold the lower jaw slightly forward. This will advance the tongue and soft tissues of the throat to open the airway and restore normal breathing during sleep. The MADs have an adjustment mechanism built into the device that allows the patient to gradually change the position of the bottom jaw, under the dentist's supervision, to improve the effectiveness of the device. Since the appropriate jaw position to achieve success with treatment is unique to each patient this is a very valuable feature.
The tongue retaining device is custom-made using a softer, pliable material with a compartment that fits around the tongue to hold it forward by means of suction. This device is used most for patients with dentures or patients who cannot adequately advance their lower jaw. The patient must be able to breathe well through their nose or they may have difficulty tolerating this appliance.
Our office is unique in that we use six different oral appliances. The choice
of which appliance will be used for each patient is based on many factors.
These factors include severity of the apnea condition, patient's bite and
jaw structure, size of the tongue and soft palate, presence of tooth clenching
or grinding, jaw range of motion, health of teeth and gums, and many others.
Dr. Parker will use his experience and expertise to help guide the patient
to using the appliance that will be most comfortable and effective for
that individual's situation. Dr. Parker has used many different appliances
over the past fourteen years, but currently he is using:
The Adjustable PM Positioner is a custom-made appliance constructed 
of
a heat-sensitive acrylic that fits over the upper and
lower teeth. The appliance is comfortable on the teeth and leaves added space
for the tongue compared to other devices. It allows a small amount of jaw
movement (4mm) so that the patient does not feel "locked into position".
The adjustment mechanisms are on the cheek side of the appliance near the
molars and 
allows
for easy advancement of the jaw position to improve effectiveness of the
device when it is indicated. This appliance is used most frequently in our
office because of its ease of use, effectiveness and durability.
A rotating view of this appliance is available by clicking the image to the left. (Animation may take a few seconds to load - please be patient.)
The SUAD is also a custom-made appliance that is made of a heat-sensitive
acrylic and is reinforced by a metal framework. The 
adjustment
mechanism (Herbst) is positioned on the sides of the device and consists
of a piston that slides within a tube. The appliance is comfortable on
the teeth and the mechanism allows good freedom of movement of the jaw.
Therefore it is used frequently in patients who tend to grind their teeth
heavily. The position of the jaw can be adjusted by using small rings that
slide over the piston and when the tube is positioned over the piston it
will advance the jaw the width of the ring. Small elastics (rubber bands)
are used to keep the jaw from falling open during the night although the
patient is able to partially open the mouth, which can improve comfort when
using the appliance.
The EMA is another custom-made appliance that fits over the 
upper and lower
teeth and is connected by rubber straps on the sides of the device. This
appliance uses a thinner plastic and may be less intrusive for patients
who have smaller mouths or a concern about wearing something in their mouth.
There are five sets of straps of different lengths and flexibilities to
allow for advancing the jaw position gradually, although it does not have
as much adjustability as some of the other appliances. This appliance allows
reasonably good jaw movement, but it is not as durable as some of the other
devices.
Tongue Retaining Device (TRD) is a custom-made appliance 
made
of a soft, pliable material that has a compartment in which the tongue is
held in place by means of suction. This appliance is most frequently used
for patients who have very few or no teeth. The TRD may require some time
for the patient to adapt to having their tongue held in place, so a tongue
exercise and adaptation program is started a few weeks prior to the date of
insertion of the device. This appliance may be difficult to tolerate if the
patient has trouble breathing through their nose.
Silent Nite and SnoreAid are other appliances currently used in the office. The Silent Nite is a smaller appliance that is very comfortable to wear and can be effective for patients who are primarily snorers or have very mild apnea. However it is less durable and has much less adjustability. The SnoreAid appliance can be fitted the day of the appointment, which is a great option for patients who need the appliance immediately (if they are leaving on vacation the next day, etc.). However these devices are much less durable.
The Adjustable PM Positioner , SUAD, EMA and Tongue Retaining Device are all FDA accepted for snoring and sleep apnea. The Silent Nite and SnoreAid are FDA accepted for snoring only.
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 -15 events/hr.), 60% effective for patients with moderate sleep apnea (15 - 30 events/hr.) and 40% effective for patients with severe sleep apnea (more than 30 events/hr.).
The patients in our office have had higher success rates than the published research, most likely because we use six different oral appliances and we use a slightly different treatment process.
Follow-up
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. During the follow-up sleep study the jaw position on the appliance can be adjusted to increase treatment success. Following the sleep study a consultation with the sleep medicine physician will be necessary to discuss the results.
The American Academy of Sleep Medicine has stated that oral appliance is indicated
as a first treatment of choice for patients with primary snoring and/or mild
obstructive sleep apnea and as a second treatment option for patients with
moderate or severe sleep apnea who cannot tolerate CPAP and/or are not good
candidates for surgery.
Therefore, oral appliance therapy is indicated for:
" Primary/heavy snoring
" Mild or moderate sleep apnea and certain cases of severe OSA
" Poor tolerance of nasal CPAP
" Failure of surgery
" Use during travel
" In combination with nasal CPAP
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:
The potential side effects that can be more problematic include:
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 30 - 40% of the patients. Although the changes may be slight it may still be difficult for the patient to close their back teeth together, which may have an effect on their ability to chew effectively. The slight movement of teeth and loosening of dental restorations occurs very infrequently (1% of the patients) but is still worth noting.
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Snoring & Sleep Apnea Dental Treatment Center
7225 Ohms Lane, Suite 180
Edina, MN 55439
952-345-0290
© 2002 - 2008. Jonathan Parker, DDS. All Rights Reserved.
