What is oral appliance therapy for obstructive sleep apnea?

Oral appliance therapy is an effective treatment for obstructive sleep apnea (OSA). Worn only during sleep, an oral appliance fits like a sports mouth guard or an orthodontic retainer. It supports the jaw in a forward position to help maintain an open upper airway.

A custom-fit oral sleep appliance can improve sleep, restore alertness and revitalize health. A qualified dentist can provide oral appliance therapy. Oral appliance therapy is covered by many medical insurance plans.

This content originally appeared on the American Academy of Dental Sleep Medicine (AADSM) website.
Phil Westbrook
Sleep Medicine

Oral appliance therapy (OAT) for obstructive sleep apnea (OSA) is a way of mechanically expanding the upper airway so that it resists collapse when you sleep.

There are two kinds of oral appliances, but both involve moving the tongue. One type, the tongue retaining device (TRD), works by enveloping the tongue in a soft plastic cavity and holding it in place by suction. The TRD is shaped to fit on the teeth sort of like a mouth guard, in such a way as to position the tongue forward off the back of the throat. The other type, the mandibular advancing appliance (MAA), is a device that fits over the upper and lower teeth. The upper teeth serve as an anchor, and the part of the device on the lower teeth can be advanced so that the lower jaw, the mandible, is moved forward. Because the tongue is attached to the point of the lower jaw, moving it forward moves the tongue off the back of the throat and increases the size of the upper airway.

Of the two kinds of oral appliance the MAA is much more widely used, and most of the research on OAT involves this type of appliance. Research suggests that the appliances that are custom fitted to a patients teeth work the best, and this fitting is usually done by a dentist knowledgeable about MAA treatment of OSA. The adjustable appliances allow the advancement of the mandible to be titrated to maximize the treatment efficacy possible in any individual patient. In a sense the upper airway is a tube in a container of soft tissue in a bony box. The MAA enlarges the box, reducing the amount of collapsing pressure the tissue exerts on the airway.

MAA therapy can works even it those with quite severe PSA. Although it does not reduce the frequency of obstructive events, the apnea/hypopnea index (AHI), as dramatically as continuous positive airway pressure, it reduces the AHI by over 50% in about 60% to 70% of patients in whom it is used, and lowers the AHI to less than 10 in about half. It is more likely to be successful in younger patients, those with less obesity, and those who have most of their obstructive breathing when they are sleeping on their back.

Not everyone can use a MAA. For one thing, you have to have teeth. Some folks have jaw pain that prevents use. There are side effects such as changes in one's bite and excessive salivation. However most patients who have tried both CPAP and OAT prefer the later, and appear much more likely to use it properly.

Oral appliance therapy is one of 3 ways to treat obstructive sleep apnea. This therapy involves wearing a device that is fitted and worn in the mouth and holds the lower jaw forward to keep the airway open during sleep.

The other ways to treat sleep apnea include various surgeries or CPAP, a machine that blows air through the mouth and/ or nose to keep the airway open.

Which treatment is best varies from person to person and is best discussed with the patient and their sleep physician.

Since obstructive sleep apnea is a life threatening condition it is best treated with care givers that have training and experience treating sleep apnea.

Dante A. Gonzales, DMD
Orthodontics & Dentofacial Orthopedics

Oral appliance therapy (OAT) for obstructive sleep apnea is one alternative to surgery or a CPAP (continuous positive air pressure) machine.  Many sleep apnea patients opt for OAT therapy because it is less invasive than surgery and much easier to sleep with than using a CPAP machine. 

The oral appliance is usually a mandibular repositioning device that holds the lower jaw in a protruded position. Because the tongue is attached to the lower jaw (mandible) the tongue is moved forward along with the lower jaw and this helps keep the airway open. 

Typically, when sleep apnea patients lie down and fall asleep the muscles of the mandible relax as do the tissues that surround the airway, i.e. the tongue. The tissues collapse and the airway closes until the patient wakes up gasping for air. This can take place dozens or hundreds of times per night depending upon the severity of the sleep apnea. 

Because these devices are anchored to the teeth, and thus can effect the teeth, they should be delivered by a dentist or dental specialist that is familiar with the treatment of sleep apnea. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.