Oral Appliance Therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnea are devices worn in the mouth, similar to orthodontic retainers or sports mouthguards. They have several advantages over other forms of therapy. Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive.
Oral appliance therapy has been recognized by the medical community as an effective treatment option in the management of sleep breathing disorders. Medical and dental researchers have joined together to evaluate and improve the outcome of treatment with oral appliances.
Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery or nasal continuous air pressure (CPAP). Oral appliances work in several ways:
- By repositioning the lower jaw, tongue, soft palate and uvula
- By stabilizing the lower jaw and tongue
- By increasing the muscle tone of the tongue
Oral appliance therapy can take from several weeks to several months to complete. Even after the intial phase of treatment is complete, we will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.
Our office is pleased to provide the following information about the type of oral appliance therapy we provide.
SomnoMed MAS The SomnoMed MAS is a custom-made device, consisting of upper and lower dental plates with a unique patented fin-coupling component, which allows normal mouth opening and closing. If required, a part can be added to make the device adjustable. This feature provides incremental and adjustable levels of lower jaw advancement, which improves the effectiveness and comfort-level of treatment as the jaw is moved only as far as is required to alleviate snoring and reduce OSA. Key features and benefits of the device include: Permits normal mouth opening; Allows speech and drinking; Provides full lip-seal; Easily adjustable; Safe and effective; Clinically proven; Custom-fitted; Additionally, the SomnoMed MAS is made from durable fade-proof acrylic that retains its shape and color for a long time and is covered by a two year manufacturer's warranty.
The Thornton Adjustable Positioner (TAP®) oral appliance is a mandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism which permits unlimited advancement of the lower jaw. The arches are custom fit to a patient's models. The advancing mechanism is engaged and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5 mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable.
Elastic Mandibular Advancement Appliance (EMA)
The EMA® - Custom appliance is a simple, patient-friendly oral appliance created for noninvasive treatment of snoring and OSA. The primary treatment mechanism of opening the bite and gently moving the mandible forward is achieved with the use of interchangeable elastic straps that offer varying degrees of mandibular advancement. The flexibility of these elastic straps provides unsurpassed lateral movement and overall TMJ comfort. The 2 mm thick pressure formed bases offer orthodontic retention (resulting in no tooth movement) and maximum anterior tongue space because there are no projections in the palate.
The Herbst Telescopic Appliance has been proven to be effective on chronic snoring and mild to moderate obstructive sleep apnea sufferers. This appliance allows patients to move laterally and vertically without disengaging the appliance. Also, if it is determined that the initial position does not provide the anticipated relief of the condition, the mandible can easily be moved forward by two options of adjustability. The first option is traditional hardware with sets of 1,2 and 3 mm shims for advancing those increments only. The second being the Telescopic version allowing the clinician to advance in ¼ mm increments by making one full turn of the protrusion collar up to 6-8mm from the start position. The appliance can be fabricated from hard acrylic, thermoactive and soft materials and is tooth retained via friction grip or clasps.
The Herbst Appliance is a mandibular repositioner that has been in use many years for orthodontic and TMJ therapy prior to its modification for treatment of sleep disordered breathing.
The greatest advantage of the Herbst appliance is that it allows for very quick, easy and accurate mandibular protrusive adjustability. This is accomplished through simple manipulation of the rod/sleeve plunger mechanism. Vertical opening varies is 5 mm and there is limited freedom of movement for the mandible in a lateral direction. Bilateral interarch elastics are recommended to keep the jaw closed during sleep.
NOTE: Some clinicians feel that limited lateral movement of the lower jaw during appliance use is beneficial for TMJ comfort while others believe it is of no benefit. Also, some clinicians find compromised effectiveness if the mandible is allowed to drop down even as much as a millimeter during appliance use while others find no difference. These are both areas that require more scientific study. We are presently unaware of the precise effect of these parameters on appliance effectiveness.
The Tongue Retaining Device (TRD) is lab constructed of a flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.
The appliance is available in four tongue extensions and with or without air way tubes for patients with compromised airway patency. It is constructed in conjunction with the Kelly Gauge (described in another section of this program.)
Since the mandible is not rigidly or firmly held by the appliance, freedom of movement is possible during use. This would seem to make the TRD a good choice for the edentulous patient, the patient with periodontal disease and the patient with temporomandibular joint dysfunction.
There is sample research available documenting the effectiveness for treatment of snoring and OSA in certain patients.
NOTE: Mandibular repositioners have been successfully used in edentulous patients over dentures in certain cases where the dentures have had adequate retention. Mandibular repositioners have also been successfully used in patients with compromised periodontal status or TMJ function. In these cases, however, the clinician needs to be especially careful in design and follow up.
The OASYS Oral/Nasal Airway System™ is the first dental device to treat both the nasal and oropharyngeal problem area with one system. The OASYS Oral/Nasal Airway System™ strengthens the throat area by pulling the lower jaw and tongue forward to prevent the tongue from blocking the airflow and strengthening the throat against collapse. The nasal button create a gentle stretch of the upper lip region putting a traction on the inner nasal tissue to dilate the nose increasing the nasal volume up 300% and reduce the resistance up to 80%.
Norman Blumenstock, DDS, MAGD, D.AAPM, D.ABDSM
DentalSleepMedicine.net
410 Spotswood-Englishtown Road
Monroe Township, New Jersey 08831
Ph:732-251-7766
Fx:732-251-7676
Email: staff@dentalsleepmedicine.net
Web-Site: http://www.dentalsleepmedicine.net
Office Hours: Monday-Friday 8am to 7pm