A recent update of the clinical practice parameters of the American Academy of Sleep Medicine (AASM) state that oral appliances are indicated for the treatment of mild-to-moderate Obstructive Sleep Apnea in patients who prefer oral appliances to CPAP, who do not respond to CPAP, who are not suitable for treatment with CPAP, or for whom treatment attempts with CPAP are unsuccessful. CPAP is a more efficacious treatment, it is recommended that CPAP be considered before oral appliances for patients with severe OSA (Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update. Sleep 2006).
Oral appliances are an alternative option for patients who can’t tolerate CPAP therapy, they are considered by patients to be a more acceptable treatment modality compared to CPAP. Oral appliances are portable and do not requires a power source. The greater acceptance by patients of oral appliances results in better treatment adherence.
Oral appliances are removable devices used at nighttime to prevent the collapse of the tongue and the soft palate onto the back of the throat. These are attached to the upper and lower teeth, and then mechanically move the lower jaw forward to keep the airway open during sleep. The objective of these devices is to improve the patency of the upper airway during sleep by increasing its dimensions and reducing its collapsibility.
Several anatomic changes occur as a result of the mechanical advancement of the mandible and tongue. The Lateral x ray below shows a patient with a narrow airway (left), the same patient wearing an oral appliance improving the airway patency (right).
Currently there are at least 40 different designs of oral appliances available to specially trained dentists to treat snoring and sleep apnea.