In this article we will briefly recount what obstructive sleep apnoea is, and the role of mandibular advancement devices in managing it.
Is Obstructive Sleep Apnoea Dangerous?
Obstructive sleep apnoea (OSA) is a rising problem globally due to a combination of factors, such as the obesity epidemic, genetics and lifestyle choices. It can impact a person’s quality of life negatively both on a short and long-term basis. OSA patients often snore and gasp for air whilst sleeping, which also affects their sleep partner. Many couples even practice “sleep divorce”, where they sleep in separate rooms due to such noise disturbances.
Fatigue from a poor night’s sleep results in daytime sleepiness. That in turn impacts cognition, and can also pose a public health risk if you drive. In the long-term, obstructive sleep apnoea can lead to heart attacks, strokes, hypertension, diabetes and other serious medical issues.
Read the following posts on our website for more information on sleep apnoea:
What are Mandibular Advancement Devices?
Oral appliances are effective when it comes to the management and treatment of obstructive sleep apnoea. The two types of oral appliances used for this purpose are mandibular advancement devices (MADs) and tongue-stabilising devices (TSDs).
You may have also heard of mandibular advancement devices referred to as:
- Mandibular advancement splints
- Sleep apnoea mouth guards
- Sleep apnoea dental appliances
- Sleep apnoea oral appliances
Here is a short video by the American Academy of Dental Sleep Medicine that shows how mandibular advancement devices can help with obstructive sleep apnoea:
Prefabricated vs Custom-Made Mandibular Advancement Devices
Prefabricated mandibular advancement devices can be bought over-the-counter, but these are generally not recommended as obstructive sleep apnoea is highly individual. Genetics, craniofacial anatomy, the neuromuscular system and other underlying medical conditions need to be taken into account (Manetta et al., 2022). Every patient’s oral cavity structure differs widely as well. The chances of a suitable one-size-fits-all solution is extremely low, and might even compound dental issues.
Custom-made mandibular advancement devices come in different configurations, such as non-adjustable monoblocks, and adjustable bi-blocks. Coupling mechanisms such as elastic straps and springs often accompany non-adjustable MADs (Manetta et al., 2022). Mandibular advancement devices also come in a variety of materials, such as hard acrylic, soft elastomer, thermoplastic and more.
In one multicentre study on the use of mandibular advancement devices for the treatment of obstructive sleep apnoea, it was shown that there was reduction in AHI (Apnea Hypopnea Index) in 93% of the patients, and that more than 30% of them were cured of OSA. It also reflected that custom oral appliances performed better, as compared to thermoplastic or prefabricated MADs (Anitua et al., 2023).
How do Mandibular Advancement Devices Work, and Who are They Meant for?
Mandibular advancement devices have been shown to be effective for patients with mild to moderate obstructive sleep apnoea. They are also used for patients who cannot tolerate CPAP (nasal continuous positive airway pressure therapy) (Cunali, 2009).
As the upper airway collapses in obstructive sleep apnoea, mandibular advancement devices work by protruding the lower jaw forward, which moves the soft tissues of the tongue and soft palate as well. This all helps to expand the dimensions of the upper airway and to reduce its collapsibility (Mohammadieh et al., 2023). Whilst mandibular advancement devices are effective for obstructive sleep apnoea, they do not help with central sleep apnoea as the origins of the problems differ.
What is the Process Like in Getting a Custom-Made Mandibular Advancement Device?
Before getting a mandibular advancement device made, it is vital for your dental sleep specialist to gather details of your medical history (if any), medications you may be on, your symptoms, dental and sleep problems, and also do a physical examination. This will usually include questionnaires that assess both daytime and night time symptoms, measuring of your neck circumference, BMI and blood pressure, examination of the orofacial region and tongue, and more (Levine et al., 2018).
A polysomnography (sleep study) is the gold standard for diagnosing obstructive sleep apnoea, and your dental sleep specialist will most likely conduct one beforehand (Flouris and Millar, 2023). These may require you to stay at the facility overnight, although there are devices that allow you to conduct the study from the comfort of your own bed these days. Dental x-rays and other tests may need to be done depending on the patient, and what your dental sleep specialist requires for optimal treatment.
This examination phase is important as it helps your dental sleep specialist to identify the type of sleep apnoea you have, whether it is mild or severe, form a baseline for future reference, and also to rule out other possible diagnoses. TMJ disorders, if any, need to be taken into account as well in order for effective treatment, as they can either contribute to or result from obstructive sleep apnoea.
If you are found to be a suitable candidate, your dental sleep specialist will then take models of your teeth in order to craft your custom-made mandibular advancement device. They will discuss and determine the material, size and type of mandibular advancement device that will best suit you, as there is no ‘best’ option, only what is most fitting for each individual.
Side Effects of Mandibular Advancement Device Usage, and the Importance of Follow-Up Care
Whilst a mandibular advancement device might feel foreign in your mouth and cause some discomfort the first few times you use it, most patients subsequently adapt with no significant issues. Some side effects that patients might experience include: excess salivation, dry mouth, and other forms of pain in the orofacial region (Cunali et al., 2009).
Thus, it is important that you attend follow-up appointments with your dental sleep specialist, as they can help with mandibular advancement device adjustments in order to maximise comfort, and to achieve the desired results (Marklund et al., 2012).
How Nourish Dental Sleep & TMJ Care Can Help with Relieving OSA with MADs
Dr. Eric Chionh runs the practice at Nourish Dental Sleep & TMJ Care in Singapore, together with a dedicated team. He is formally trained in Oral Medicine and Orofacial Pain, with over 20 years of hands-on experience. He holds a Singapore Dental Council approved qualification in these areas, and is an American Board of Orofacial Pain (ABOP) board-certified specialist in orofacial pain/TMD, which is recognised by the American Board of Dental Specialties (ABDS) and the American Dental Association (ADA).
Dr. Chionh is a *qualified sleep dentist under the European Academy of Dental Sleep Medicine (EADSM) and American Academy of Dental Sleep Medicine (AADSM), and holds a Diplomate (International Certificant) under the American Board of Dental Sleep Medicine (ABDSM).
He has a keen interest in Dental Sleep Medicine, including Obstructive Sleep Apnoea. He strives to keep himself updated on the latest medical and dental literature, and is passionate about improving his patients’ quality of life using the latest evidence-based medicine and guidelines. He takes the time to discuss treatment options, and concerns that patients may have.
Our clinic also uses suitable technology to assist with the proper diagnosis and management of obstructive sleep apnoea, TMD and orofacial pain. Visit our About page to learn more about Dr. Eric Chionh and his credentials, and our Services page to view all services provided at Nourish Dental Sleep & TMJ Care.
References:
- Anitua, E., Mayoral, P., Almeida, G. Z., Durán-Cantolla, J., & Alkhraisat, M. H. (2023). A multicenter prospective study on the use of a mandibular advancement device in the treatment of obstructive sleep apnea. Dentistry Journal, 11(11), 247. https://doi.org/10.3390/dj11110247
Cunali, P. A., Almeida, F. R., Santos, C. D., Valdrighi, N. Y., Nascimento, L. S., Dal’Fabbro, C., Tufik, S., & Bittencourt, L. R. (2009). Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy. Journal of orofacial pain, 23(4), 339–344..
Flouris, L., & Millar, B. (2023). Evaluation of a custom-made mandibular repositioning device for the treatment of obstructive sleep apnoea syndrome. British Dental Journal, 235(6), 385-390. https://doi.org/10.1038/s41415-023-6267-x
Levine, M., Bennett, K., Cantwell, M., Postol, K., & Schwartz, D. (2018). Dental sleep medicine standards for screening, treating, and managing adults with sleep-related breathing disorders. J Dent Sleep Med, 5(3), 61-68. https://doi.org/10.15331/jdsm.7030
Manetta, I. P., Ettlin, D., Sanz, P. M., Rocha, I., & e Cruz, M. M. (2022). Mandibular advancement devices in obstructive sleep apnea: An updated review. Sleep Science, 15(Supp 2), 398-405.https://doi.org/10.5935/1984-0063.20210032
Marklund, M., Verbraecken, J., & Randerath, W. (2012). Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. European Respiratory Journal, 39(5), 1241-1247. https://doi.org/10.1183/09031936.00144711
Mohammadieh, A., Tong, B., De Chazal, P., & Cistulli, P. A. (2023). Innovations in mandibular advancement splint therapy for obstructive sleep apnoea. Frontiers in Sleep, 2, 1144327. https://doi.org/10.3389/frsle.2023.1144327