More people are being diagnosed with obstructive sleep apnea every day.  With this increase it is important to develop new ways of treating this disorder.  PAP, positive airway pressure, devices are considered the gold standard of treating sleep apnea.  The problem is that there are patients who are unable to tolerate this therapy.  One of the options for people who are unable to tolerate PAP is an oral appliance or dental device. 

These devices work best for those who have mild to moderate sleep apnea.  Mild sleep apnea is defined as 5-15 respiratory events per hour.  Moderate sleep apnea is defined as 15-30 respiratory events an hour.  Anyone who has more than 30 respiratory events per hour is considered to have severe sleep apnea and although they can use an oral appliance it is not as successful in treating this disorder.

There are two different types of oral appliances, mandibular advancement devices and tongue retention devices.  The MRA devices work by advancing the mandible or lower jaw forward 6-11mm to help open the back of the airway.  TRA devices work by pulling the tongue forward and that helps to keep the airway open. 

MRA devices are generally fitted and adjusted by a dentist.  Ideally you should go to a dentist that specializes in sleep dentistry.  You can get a list of registered dentists at http://www.aadsm.org/FindaDentist.aspx.  These dentists are board certified in this specialty and have the ability to fit you with the correct device and to do any follow up testing you may need.  The dentist will take an impression of your teeth and create an oral appliance that will fit you and cause the least amount of side effects while opening your airway sufficiently to correct your sleep apnea. 

The TRA devices are also fitted by a dentist however there are several styles that are available to buy directly and to then self-fit by the boil and bite method.  These particular devices work best for patients who have an oversized tongue. 

Some of the side effects of these devices are drooling, your teeth shifting, tooth pain and sometimes jaw pain.  According to current research it does not appear that the devices contribute to TMJ.

Patient with severe sleep apnea may consider using an oral appliance in conjunction with the CPAP because you might be able to decrease the pressure of the PAP device. 

The ability to have a choice of therapy for obstructive sleep apnea is a great advance for people.  Not everyone can tolerate CPAP or BIPAP but they still need to have some treatment for their sleep disorder. 

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