OBSTRUCTIVE SLEEP APNEA
Treatment with an Oral Appliance

Obstructive Sleep Apnea (OSA) is a common chronic disorder of sleep and breathing that may present as pathological sleepiness with respiratory and/or cardiovascular complications. OSA is related to repetitive partial or complete upper airway obstruction, which develops during sleep with manifestations that include snoring, apnea, and hypopnea. Although nasal continuous positive airway pressure (CPAP) is the gold standard treatment, a significant number of patients are unable to tolerate it, and compliance many times is a problem (approximately 65%). Oral appliances (OA) are prescribed as an excellent alternative therapeutic approach. The treatment is simple, reversible, cost-effective, and is endorsed by the Academy of Sleep Medicine (AASM). Additionally, the appliance has been approved by the Food and Drug Administration (FDA), and has been classified as a medical device.

The oral appliance is fabricated with an acrylic polymer. It secures to both the upper and lower dental arches by the use of metal clasps with an expansion screw for adjusting. Each turn or activation gradually advances the mandible, which in turn pulls the tongue forward. Thus, the three-dimensional size of the airway increases and improves the patient’s ability to breathe comfortably (increases the flow of oxygen).

This form of treatment is medical therapy performed by a dentist using a medical device in the oral cavity. The treatment must not be mistaken as dental, although a dentist best performs it because of the orthognathic principles involved. The dentist, however, must not only be expert in assessing the viability of the teeth and their ability to support the OA, but he/she must be very knowledgeable in the care of the temporomandibular joints and associated oral structures. If the physician recommends the OA, a referral is sent to the dentist who proceeds with the fabrication of the OA and the follow-up care relating directly to the appliance.

Follow-up visits by the dentist are necessary to evaluate the health of the oral structures and integrity of the occlusion while using the OA. As well, the health of the TMJs must be maintained as the Mandibular condyle is pulled and kept in a forward position. The patient’s physician will do post treatment testing and follow-up care regarding the patient’s medical progress.