Obstructive Sleep Apnea (OSA) is a widespread breathing disorder characterized by the repeated collapse of the upper airway during sleep. This collapse leads to pauses in breathing and fragmented rest, which can cause significant health issues. While standard orthodontic retainers maintain tooth alignment, specialized dental devices are an effective treatment option for OSA. These therapeutic appliances physically adjust the mouth’s structures to keep the throat open, offering a non-surgical approach for relief from snoring and interrupted sleep.
Clarifying the Devices Used for Sleep Apnea
The devices used to treat Obstructive Sleep Apnea are fundamentally different from standard orthodontic retainers, which only prevent teeth from shifting. The medical devices prescribed for OSA are known as oral appliances (OAs) and are custom-made for therapeutic purposes. They are fabricated by a specialized dentist after a medical diagnosis of sleep apnea.
There are two primary categories of these appliances. The most common is the Mandibular Advancement Device (MAD), which resembles a sports mouthguard designed to snap over the upper and lower teeth. The second type is the Tongue Retaining Device (TRD), which holds the tongue in a forward position. These appliances manipulate anatomical structures to prevent the soft tissues of the throat from collapsing into the airway.
How Oral Appliances Physically Treat Apnea
Obstructive Sleep Apnea occurs when the muscles supporting the soft palate, tongue, and throat relax during sleep, causing soft tissues to collapse and block the passage of air. Oral appliances counteract this physiological problem by physically altering the dimensions of the upper airway.
MADs are designed to advance the lower jaw, or mandible, slightly forward and downward. This action creates tension on the soft tissues in the back of the throat and stabilizes the tongue, which is anchored to the lower jaw. By moving the jaw forward, the MAD effectively widens the pharyngeal area, preventing the backward collapse of the tongue base and soft palate during inhalation. The result is a mechanically maintained open airway, which reduces the number of apnea and hypopnea events. TRDs use a small suction bulb to hold the tongue tip in a forward position, preventing the tongue from falling back to obstruct the airway.
Comparing Oral Appliances to Other Treatments
The established treatment for moderate to severe OSA is Continuous Positive Airway Pressure (CPAP), which uses pressurized air delivered through a mask to splint the airway open. Oral appliances are formally recognized as a first-line treatment for patients with mild to moderate OSA. They are also recommended for individuals with severe apnea who cannot tolerate or comply with CPAP therapy.
Compliance is a significant factor in treatment success, and patients often use oral appliances more consistently than CPAP due to their small size and quiet operation. OAs offer convenience and portability, making them ideal for travel since they do not require electricity or a bulky machine. However, CPAP is generally more effective at reducing the Apnea-Hypopnea Index (AHI)—the measure of breathing events—especially in severe OSA cases. Potential side effects include temporary jaw soreness, tooth movement, and excessive salivation. The choice depends on the severity of the condition and patient preference regarding comfort and lifestyle.
The Process of Getting a Prescribed Appliance
Obtaining a therapeutic oral appliance begins with a medical diagnosis of OSA, typically confirmed through an overnight sleep study or a home sleep apnea test. Once diagnosed, a sleep physician determines if an oral appliance is suitable and issues a prescription. The patient then sees a dentist specializing in dental sleep medicine, who conducts a thorough examination of the oral structures, including the teeth, jaw, and temporomandibular joint (TMJ) function.
The custom-fitting process involves taking precise impressions or digital scans and bite registration measurements. These records are sent to a laboratory where the appliance is fabricated to hold the jaw or tongue in a precise, advanced position. Follow-up visits are crucial for the dentist to adjust the device, ensuring it is correctly titrated to the optimal jaw position, and often include a repeat sleep study to confirm therapeutic success.