Oral Appliance Therapy - Overview
Advances in oral appliance design and associated technology has steadily progressed over the past 20 years. Dr Pence is well versed in the state-of-the-art options. The appliances, and screening/titration monitors in use at Lake Norman Dental Sleep Medicine represent those that have been well researched and documented to produce positive results for our patients.
Oral appliances have been in use for over 20 years to effectively treat snoring and obstructive sleep apnea. Currently over 40 different appliance designs are available to specially trained dentists for this use. Many scientivic studies have been published that demonstrate the effectiveness of these appliances when utilized by trained and experienced sleep-disorders dentists.
Oral appliances are placed in the mouth much like an orthodontic retainer or an athletic mouth protector. They are utilized during sleep to prevent the collapse of the tongue and soft tissues in the back of the throat, so that the airway remains open during sleep. The appliances promote adequate air intake, thereby helping to promote normal sleep for those who suffer from snoring and/or obstructive sleep apnea. Oral appliances can be used alone, or in combination with CPAP, or after surgery. Determination of proper therapy can only be made by joint consultation between your sleep-disorder dentist and your sleep physician. All appliances and devices are FDA approved.
Types of Oral appliances
Of the many appliance available today, each falls under on of two categories based on mode of action. The first and largest category is that of the "mandibular repositioning device". By far the majority of all appliances in use today fall into this category. These devices serve by gently repositioning the lower jaw forward during sleep. The second category is that of the "tongue retaining device". These appliances are seldom used, but can be very effective for many people, especially those with few teeth, no teeth, or jaw joint problems. Tongue retaining devices function by protruding the tongue forward during sleep.
The Thornton Adjustable Positioner (TAP®) oral appliance is a mandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism which permits unlimited advancement of the lower jaw. The arches are custom fit to a patient's models. The advancing mechanism is engaged and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable.
What to Expect During Treatment
The first step in being treated for snoring or obstructive sleep apnea is to obtain an evaluation by a sleep physician who will provide a formal diagnosis based on a medical sleep study. After that, an evaluation by a sleep-disorders dentist will determine whether you are a good candidate for oral appliance therapy and which oral appliance will be most effective.
Your first dental appointment will involve a discussion of the problem, review of your medical status and a detailed focus on the advantages, limitations and risks of oral appliance therapy. Different appliance types will be discussed and one x-ray will be taken of your teeth and jaw joint. A thorough examination of your teeth, jaw joint and bite will be performed. Impressions will be taken of your teeth for fabrication of the appliance and a photograph will be taken of your bite.
Your second appointment will involve custom fitting the oral appliance and learning how to use and care for it. After that, you will return in approximately 4 weeks for a follow-up visit to monitor the effects of the appliance and to make any necessary adjustments to ensure comfort and effectiveness.
Ultimately, when the snoring and daytime sleepiness have been resolved you will be referred back to your sleep physician for a follow-up sleep study to ensure the effectiveness of the appliance. You will then be examined annually by Dr. Pence to ensure adequate long-term success and to monitor any possible side effects.
Dental professionals at LKN Dental Sleep Medicine can work with you to understand the health risks and treatment options for your problem snoring.