Sleep Apnea

Description

Other Treatments

Several different dental appliances or treatments are available and are proving to be very valuable treatments for mild to moderate obstructive sleep apnea. Dentists and orthodontists are slowly becoming more aware of obstructive sleep apnea and may become more involved with its diagnosis and treatment. Among the devices available are the following examples:

• The mandibular advancement device (MAD) is the most widely used dental device for sleep apnea. It is similar in appearance to a sports mouth guard. MAD forces the lower jaw forward and down slightly, which keeps the airway open.
• Splints (e.g., Sleep Splint) are sometimes used that hold the tongue in a specific position to keep the airway as open as possible.
• The functional magnetic system uses two magnets positioned on opposite sides of the jaw to keep the airway open.

Patients fitted with one of these devices should have a check-up early on to see if it is working; short-term success usually predicts long-term benefits. It may need to be adjusted or replaced periodically.

Benefits of Mandibular Advancement Device

Studies generally indicate satisfaction with the dental devices. MAD and similar devices seem to offer the following benefits:

• They reduce apneas significantly for those with mild to moderate apnea, particularly if patients sleep either on their backs or stomachs. (They are not as effective if the patient lies on his or her side.) They may also improve airflow, although less well, in those with severe apnea.
• They improve sleep in many patients.
• They improve and reduce the frequency of snoring and loudness of snoring in most (but not all) patients.
• Compliance rates are usually much higher than with CPAP.

In one 2002 report, long-term use of a dental device achieved an 81% success rate, which was significantly higher than the 53% success rate noted for uvulopalatopharyngoplasty (UPPP), the standard surgical treatment. There were also few complications with the dental device.

Disadvantages of Dental Devices

Dental devices, including MAD, are not as effective as CPAP therapy, but patients may be more satisfied with them. They do have side effects, however. For example, the following problems are reported with MAD devices:

• Side effects of MAD can include nighttime pain, dry lips, tooth discomfort, and excessive salivation. In general, these side effects are mild, although over the long term, nearly half of patients stop using them. Devices made of softer materials may produce fewer side effects.
• In some cases of long-term use, permanent changes in the position of the teeth or jaw have occurred. Periodic check-ups with a health professional are advised.
• The cost for these devices tends to be high ($500 to $2,000).
• In a small percentage of patients, the treatment may worsen apnea. Patients should be monitored with polysomnography before and after therapy.

Orthodontal Treatments

An orthodontic treatment called rapid maxillary expansion, in which a screw device is temporarily applied to the upper teeth and tightened regularly, may be beneficial for patients with sleep apnea and a narrow upper jaw. This nonsurgical procedure takes about three weeks and helps to reduce nasal pressure and improve breathing.