All About Oral Appliances
Treatment Options for Obstructive Sleep Apnea
Jeff Rodgers, DMD
Obstructive sleep apnea (OSA) is a prevalent disorder, affecting 3% to 7% of men and 2% to 5% of women in the general adult population;1 however, the number of people suffering from the condition is thought to be much higher, with an estimated 80% of cases remaining undiagnosed.2 Such a high rate of undiagnosed individuals showcases the need for greater awareness among both patients and healthcare professionals.
A Front Line in Awareness
Dental hygienists are in a unique position to drive increased awareness and identify risk factors that may indicate a patient is suffering from OSA. While it is the responsibility of the sleep physician to provide a final diagnosis, dental professionals are among the first line of defense for the condition. Many patients with sleep-disordered breathing present craniofacial risk factors that are easily discernible during a routine dental visit:
• Small or recessed chin
• Large neck circumference
• Scalloped tongue
• Overbite or Shimbashi < 18 mms
• Enlarged tonsils
• Eroded enamel
• Decreased intermolar distance with vaulted palate
It's imperative that dental professionals are aware of these craniofacial risk factors, as well as the treatment options available, in order to provide potentially life-saving sleep apnea education to patients.
The traditionally recognized treatment for sleep apnea is a continuous positive airway pressure (CPAP) machine, but oral appliance therapy (OAT), administered by specially trained dentists, is gaining awareness as a proven treatment option for mild, moderate, and even some cases of severe sleep apnea. This is primarily due to the superior adherence rate of oral appliances. While OAT has a self-reported median compliance rate of 77% of nights,3 CPAP compliance is only 30% to 60%.4 Given this high adherence, dental professionals, including hygienists, have a responsibility to raise awareness about OAT as a treatment option. To do this, hygienists need a general understanding of OAT and its efficacy in clinical practice.
An Effective Treatment Option
Oral appliances appear similar to an orthodontic mouthguard or retainer and are used to project the mandible or tongue forward, opening the airway and preventing collapse. Oral appliances fall into two broad categories: mandibular advancement splints (MAS) or mandibular advancement devices (MAD), and tongue repositioning or retaining devices (TRD).
For mild and moderate sleep apnea, oral appliances are considered a first line of treatment.5 For severe sleep apnea, oral appliances may be considered an alternative treatment for those intolerant to CPAP.6 OSA severity is determined by an individual's apnea-hypopnea index (AHI), or the number of cessations in breathing per hour.
MAS/MAD results in a complete resolution of sleep apnea (AHI reduced to < 5 per hour) in about 40% of patients.7
Oral appliances play a critical role in treating sleep apnea. Dental hygienists can answer the call in raising awareness of OSA in general and this essential treatment option, as adhering to treatment is literally a matter of life or death for patients. I, for one, am committed to joining you in the fight.
About the Author
Jeff Rodgers, DMD, D-ABDSM, D-ASBA
Sleep Better Georgia