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Dental or oral devices or appliances are considered as an option for the treatment of obstructive sleep apnoea for those who cannot handle CPAP therapy. These dental appliances are called mandibular advancement devices (MAD) or mandibular advancement splints (MAS).
How MAD Works
The dental appliance is actually a mouth guard that is fitted to the top and bottom teeth and then joined so that the bottom teeth are placed in front of the top set of teeth. The lower jaw is slightly pushed forward so that the soft tissues and muscles of the user’s upper airway are tightened to prevent obstruction of the airway during sleep.
As the airway opens up, episodes of apnoea/hypopnoea are reduced during sleep. Vibration of the upper airway tissues during exhalation and inhalation is also prevented when the airway is tightened thus preventing or minimizing snoring.
An 8mm to 10mm advancement of the lower jaw is sufficient for most OSA patients for the MAD to efficient. However, some patients may require additional adjustment on their MAD for it to fit perfectly. Some discomfort might be felt by the patient as pushing the bottom jaw forward is not exactly comfortable. Nevertheless, there are some OSA patients who feel more at ease in using a MAD than a CPAP.
Who can use MAD?
Each person has a different shape of face and airway and not all OSA patients are suitable for a MAD. Who then are good candidate for MAD? A patient with mild to moderate OSA (20 to 30 apnoea/hyponoea episodes while sleeping) is a good candidate for MAD. This oral appliance is also recommended to patients who suffer from positional apnoea/hyponea. OSA patients with a receding jaw are recommended to use MAD.
On the other hand, OSA patients with missing teeth and/or poor dental structure are not suitable to use any type of dental appliance. If a patient’s jaw joints are stiff, the 8mm to 10mm required advancement for MAD is unachievable. OSA patients who are overweight would be better of using a CPAP machine. MAD is not recommended for those with severe OSA and for those with complicated sleep apnoea.
Pros and Cons of Mandibular Advancement Device
MAD is quite effective for patients who have mild to moderate OSA. Patients with positional OSA also showed marked improvement with the use of a mandibular advancement device as their snoring decreased its loudness and frequency. MAD and other oral appliance such as tongue rotating device (TRD) and MAS were able to long-term control sleep apnoea and even better than a surgical treatment.
One of the disadvantages of using a MAD is the discomfort it brings to the wearer. Tooth discomfort, excessive saliva, pain and dry lips are some of the reported problems of MAD users. In some cases, changes in the position of the teeth and jaw have occurred. It is best to consult with a qualified dentist and physician if one intends to use MAD.
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