ORAL APPLIANCE THERAPY
What is an Oral Appliance (OA)?
Recommended by the American Academy of Sleep Medicine for mild to moderate sleep apnea and severe sleep apnea when unable to use a CPAP.

Oral devices are often called Mandibular Advancing Devices (MAD), or simply Oral Appliances (OA). These devices move the base of the tongue, the mandible (lower jaw bone), the muscles and soft tissues of the throat forward during sleep opening the airway. A small plastic splint fits over the top teeth and another over the bottom teeth. The two are connected by a small mechanism that, when in place, pushes the bottom jaw forward opening the airway.

Advantages of using an Oral Appliance (OA):
• It is very effective for most people with sleep apnea
• Excellent results with treating sleep apnea
• It is well tolerated, and patients prefer the oral device more than any other sleep apnea treatment
• It is simple to use and easy to care for
• The patient can easily adjust the appliance
• Substantial research supporting its effectiveness
• Very small appliance, simple to travel with
• The patient is not attached to a machine or tubing
• The appliance is fabricated quickly for the patient
• It is for mild to moderate sleep apnea and those unable to tolerate a CPAP

Indications for use of an Oral Appliance (OA):
• Primary snoring/Mild OSA
• Moderate / Severe OSA who are intolerant or refuse nCPAP ( as set forth by the American Sleep Disorders Association)
• Poor tolerance of nasal CPAP
• Poor surgical risks
• Non-successful UPPP surgery
• Use of appliance during travel

Are there any side effects from using Oral Appliance Therapy?:
 Patients using oral appliance therapy may experience the following side effects:
• Excessive salivation or dryness.
• Morning soreness in the teeth or jaw muscles.
• Tooth movements (mostly minor)
  Most of these side effects improve within a few weeks of regular use and some adjustments of the appliance. Patients with arthritis and chronic jaw joint dysfunction may have difficulty tolerating an OAT.

Which appliance is best for me?:
As a specially trained dentist in the treatment of OSA and oral appliance therapy, our doctors considers many factors before choosing which appliance maybe best suited for each individual.
• Travel destinations (3rd world countries, etc.)
• Preferred sleep positions
• Oral cavity restrictions (anatomical structures)
 

This drawing illustrates the benefit of an oral device in moving the jaw and tongue forward to keep the airway open while sleeping.

The lower jaw and the tongue move forward away from the airway allowing the patient to breath normally during sleep.

  The SNORING & SLEEP APNEA TREATMENT CENTERS currently prescribe 7 types of sleep apnea oral devices. Only those appliances that have proven clinical scientific research supporting their efficacy and acceptance by patients are used. There are numerous styles and varieties on the market, but will not be mentioned here. Only the appliances the SNORING & SLEEP APNEA TREATMENT CENTERS prefer to prescribe are described. Your sleep dentist, after an examination, will discuss with you whether an oral appliance would be useful for you and which type.

 
SomnoMed Appliance:
The SomnoMed MAS features medical grade stainless steel screws on the side of the appliance to provide incremental levels of jaw advancement. This optimizes the effectiveness and comfort-level of treatment, as the jaw is moved only as far as is required to alleviate snoring and OSA.

Suad Appliance:
The SUAD appliance is similar to the Herbst, but has an internal metal framework which prevents fracture of the acrylic. The hardware is the weak point. This appliance requires heating in hot water to soften it enough to place it every night.

Klearway Appliance:
This Mandibular Repositioning Appliance (MRA) is made of a Thermoplastic material which is placed in hot tap water prior to placement into the mouth. The adjustment mechanism is on the roof of the mouth and can be adjusted in .25mm increments.

PM Positioner Appliance:
The appliance fits over all maxillary and mandibular teeth and is made of a special acrylic material (Bruxeze™) that softens in hot water to provide a combination of comfort, strength, and retention. Expansion screws are located on the right and left buccal areas to allow maximum space for the tongue and easy anterior-posterior positioning of the mandible to achieve optimal effectiveness.

TAP III Appliance:
The TAP appliance has separate sections for the top and bottom Jaw. Each portion can be placed into the month independently before connecting the two. The mechanism, at least initially, sticks out through the lips making adjustments very easy.

EMA Appliance:
The EMA® - Custom appliance uses elastic to gently bring the mandible forward. These interchangeable straps offer varying degrees of mandibular advancement. The 2 mm thick pressure formed bases offer orthodontic retention (resulting in no tooth movement) and maximum anterior tongue space because there are no projections in the palate.

Silencer Appliance:
Silencer has a titanium based hinge which is beneficial to patients with particular metal allergies.

Below are two radiographs (X-Rays) of a patient a few minutes apart. In the first picture the patient is without an oral appliance, while in the second radiograph the patient has the oral appliance in place. Notice how the appliance opens the available airway space for the patient.
Note the large difference in the size of the airway opening between the 2 pictures:
In this picture (#1) the radiograph was taken without an oral device in place
This radiograph (#2) the patient has an oral device to direct the jaw forward drastically opening the airway



  CPAP: (back to top)
The CPAP, or similar device, is the most effective sleep apnea therapy at this time. CPAP stands for Continuous Positive Air Pressure and is a pneumatic device that blows air through to the lungs during sleep. This keeps the airway open and allows the patient to obtain restful sleep. There are a number of varieties of CPAP units on the market, each with their own unique advantages and disadvantages. Some units have masks that cover the mouth and nose forcing air into the lungs, while other units fit into the nostrils. Below is a picture of just one type.
 
Advantages:
• Very effective for most sleep apnea
• Can be adjusted if apnea worsens over time.
• Sometimes the device is covered by insurances.

Disadvantages:
• Most people that try CPAP can’t use them.
• The mask is uncomfortable, claustrophobia, the straps come off, etc.
• You are connected to the CPAP unit by the hose, so the patient must remove the mask during the nigh to use the restroom.
• The machine may wake some patients or their bed partners.
• The machine and mask require daily cleaning.
• The mask/hoses must be replaced every six months.
• It is difficult to travel with the CPAP and attachments.
• Sometimes the device is covered by insurances.
 
I’VE BEEN DIAGNOSED WITH SLEEP APNEA, BUT I CAN’T USE A CPAP
Many people that have already been diagnosed with sleep apnea are still, for various reasons, not managing their sleep apnea appropriately.

The most often prescribed sleep apnea therapy is a CPAP machine. If you have been prescribed a CPAP you should use the device EVERY night. The CPAP is currently the most effective therapy available for the management of sleep apnea.

The problem is that many people, possibly up to 6o%, are unable or refuse to wear the CPAP device. Those that have tried CPAP and were unable, or unwilling for whatever reason, should seek another method of management. The condition is far too serious to allow it to be untreated – that could be a deadly mistake.
There are simple and better tolerated options available. If you are in this group of sufferers that are not using your CPAP every night, please see the Snoring & Sleep Apnea Treatment Centers to discuss what is available.

  UVULOPALATOPHARYNGOPLASTY AND LASER ASSISTED UPPP
(UPPP / LAUP)Often known as a “U triple P” (back to top)
Both of these are surgical procedures to remove the excess tissues from the soft palate and throat area to enlarge the airway. One is performed with a scalpel and the other with a LASER.
 
Advantages:
• Excess tissues can be removed from the airway
• Early success is achieved with some patients

Disadvantages:
• The healing period after surgery is extremely painful
• After tissue removal the voice can have a nasal tone and food/drink may seep out the nose when swallowing
• Frequent relapse, the tissues grow back and require re-surgical excision, sometimes in as little as a few months

  ORTHOGNATHIC SURGERY (Only used when the skeletal form allows) (back to top)
Orthognathic surgery is a sectioning of the jaw bones to move it forward and then it is secured with screws and plates to hold the mandible and maxillae (jaw bones) in the new position.


Advantages:
• Effective for most apnea patients
• Can increase the chin size for those with a small chin (as in the photo above)

Disadvantages:
• Significant surgical procedure in the operating room with general anesthesia
• Painful healing course after surgery
• The patient’s face and appearance is permanently changed
• There may be some relapse over time requiring more sleep apnea treatment
• Requires both the upper jaw and lower jaw to be moved together to keep the bite normal

  PILLAR PROCEDURE
The pillar procedure places surgical stents into the soft palate to cause the palate to be more rigid.
 
Advantages:
• Simple procedure that is performed in the office
• Effective for most snoring

Disadvantages:
• The tubes can move out of the tissue
• Can be a “fullness” when swallowing
• The research is finding that it is not very successful for sleep apnea


  SOMNOPLASTY (back to top)
Somnoplasty is a procedure to cause scarring across the soft palate in an attempt to increase the rigidity and reduce the possibility of closing off the airway. Most often the procedure is accomplished with a LASER or radiofrequency waves to the soft palate.
 
Advantages:
• Effective for snoring
• Effective for some sleep apnea patients
• Post surgical healing not as painful as the UPPP

Disadvantages:
• Low effectiveness rate
• Only beneficial for the mildest cases
• Any gains are likely lost within a few months



  INSURANCE BENEFITS FOR SLEEP APNEA: (back to top)
Typically, insurance companies cover the evaluation and treatment costs for sleep apnea. Of course, this is dependent upon the individual policy.

Sleep apnea patients in the state of Wisconsin are particularly fortunate in that most medical insurance plans cover the oral appliance procedure.

Once again, each policy may be slightly different and it is best to understand what may or may not be covered prior to initiation of therapy. The Snoring & Sleep Apnea Treatment Centers offers the services of oral appliances for the treatment of sleep apnea. The Snoring & Sleep Apnea Treatment Centers’ staff will submit all the necessary medical insurance forms for its patients to determine insurance benefits. This service allows patients to make informed decisions about their healthcare.

The Snoring & Sleep Apnea Treatment Centers offer affordable payment options as well.

Snoring & Sleep Apnea Treatment Center
Phone: 414-755-4788
Central Center • 2626 N. 76th Street, Suite #101, Wauwatosa, WI 53213
Waukesha Center • 2727 N. Grandview Boulevard, Suite #100, Waukesha, WI 53188
Kenosha/Racine Center • 3500 Meachem, Racine, WI 53405
Northeast Center • 200 W. Silver Spring Drive, Suite #310, Milwaukee, WI 53217
Appleton/Green Bay Center • W3132 Van Roy Road, Appleton, WI 54915