Obstructive Sleep Apnea (OSA) is a common disorder characterized by repetitive episodes of partial or complete collapse of the upper airway during sleep. This obstruction causes breathing pauses (apneas) or shallow breathing (hypopneas), which can lead to reduced oxygen levels in the blood. For many people, treatment with a machine that provides continuous air pressure is not a comfortable or preferred option. Dental appliances, formally known as Oral Appliance Therapy (OAT), represent a highly effective, non-surgical alternative for managing OSA. This therapy works by physically keeping the airway open.
Understanding Oral Appliance Therapy (OAT)
Oral appliances work by physically repositioning the structures of the mouth and throat to prevent the collapse of soft tissues that block the airway during sleep. The most common type of device is the Mandibular Advancement Device (MAD), which resembles a custom-fitted sports mouthguard. The MAD works by engaging both the upper and lower dental arches and gently holding the lower jaw, or mandible, in a slightly forward position.
Moving the mandible forward achieves two therapeutic effects: it mechanically pulls the tongue forward, and it simultaneously tightens the soft tissues in the upper airway, such as the soft palate. This forward positioning creates a wider, more stable airway space, minimizing the risk of obstruction and the vibrations that cause snoring.
These appliances must be custom fabricated to ensure maximum comfort and therapeutic effect. The process involves a qualified dentist taking impressions or using digital scans of the patient’s teeth. A less common type is the Tongue Retaining Device (TRD), which uses suction to hold the tongue in a forward posture, often used when a patient has insufficient teeth to anchor a MAD.
Determining Patient Suitability
A successful outcome with OAT depends on appropriate patient selection, which is guided by clinical severity and anatomical factors. OAT is generally recommended as a first-line treatment for individuals diagnosed with mild to moderate Obstructive Sleep Apnea. Severity is established through a diagnostic sleep study, either a polysomnogram or a home sleep apnea test. Mild OSA is defined by an Apnea-Hypopnea Index (AHI) of 5 to 15 events per hour, while moderate is 15 to 30 events per hour.
OAT is also a significant treatment option for patients who have severe OSA but cannot tolerate or adhere to Continuous Positive Airway Pressure (CPAP) therapy. For a dental appliance to be effective and safe, the patient must meet several dental prerequisites. This includes having a sufficient number of healthy teeth to provide stable retention for the device and having no severe active temporomandibular joint (TMJ) disorders. Devices used solely for simple snoring without a confirmed OSA diagnosis are typically not covered under medical guidelines.
The Treatment Process and Maintenance
The journey to receiving an oral appliance begins with a medical referral from a sleep physician following a confirmed OSA diagnosis. The specialized dentist then takes impressions or scans of the patient’s mouth to fabricate the custom device. Once the appliance is delivered, the next phase is titration, where the device is gradually adjusted to optimize its effect.
Titration involves incrementally advancing the lower jaw forward until the device achieves the greatest reduction in airway obstruction while remaining comfortable for the patient. This fine-tuning often requires several follow-up appointments with the dental professional over a few weeks. The final step in the treatment process is an objective confirmation of efficacy, which requires a follow-up sleep study to verify the reduction in the patient’s AHI.
Patients may experience minor temporary side effects as they adjust to the appliance, such as temporary jaw soreness, excessive salivation, or dry mouth. Daily cleaning of the appliance is necessary to maintain hygiene. Long-term care involves routine check-ups with the prescribing dentist to ensure the appliance maintains its integrity and fit and to monitor any shifts in the patient’s bite or dental health.
OAT Versus CPAP Therapy
Oral Appliance Therapy is frequently compared to CPAP, which remains the most established and effective treatment for OSA, particularly in severe cases. CPAP provides a constant stream of pressurized air through a mask, which acts as a pneumatic splint to hold the airway open. While CPAP is highly efficacious, OAT offers distinct advantages in terms of patient experience and adherence.
OAT is non-invasive, quiet, and highly portable, making it a preferable option for many patients and easier for travel than a CPAP machine. A notable difference is found in compliance, which refers to how often a patient actually uses the treatment. Studies involving patients with moderate OSA have shown that the duration of nightly usage can be higher for OAT than for CPAP.
This higher adherence with OAT is thought to translate into better overall health outcomes for patients with mild to moderate OSA, even if the absolute reduction in AHI is sometimes less than that achieved by CPAP. OAT is considered a preferred first-line treatment for less severe cases and is a necessary, effective option for patients at any severity level who are intolerant of the positive air pressure mask. The choice between the two therapies involves weighing the higher efficacy of CPAP against the greater comfort and compliance offered by a custom dental appliance.