Do mandibular advancement devices actually work?
There is scientific evidence that these devices work. However, whether the device is suitable for you will be based on your history, examination and sleep study results. The Australian Dental Association and Australasian Sleep Association endorse the current guidelines by the American Academy of Sleep Medicine, which recommend mandibular advancement devices as first line therapy for snoring and mild to moderate obstructive sleep apnoea. These devices may also be used in patients with severe obstructive sleep apnoea who refuse or cannot tolerate CPAP.
Can a mandibular advancement device be used instead of CPAP?
CPAP is the gold standard for the treatment of obstructive sleep apnoea. If CPAP is working well, you should continue using it. A mandibular advancement device may be used for snoring and mild to moderate obstructive sleep apnoea. Also a device may be used if you elect not to use CPAP or cannot tolerate CPAP. A device may be used for travelling or if there is no access to power to use CPAP.
How do these devices work?
These devices works by assisting breathing during sleep by repositioning and stabilising the lower jaw (mandible) and tongue in a forward position. This helps prevent the collapse of the tongue and soft tissues in the back of the throat and thus keeps the airway open during sleep. In turn, this promotes adequate air intake (oxygen) to prevent your airway from vibrating (snoring) and obstructing (sleep apnoea).
There are so many devices, which one should I use?
There are over 100 devices available on the market. Most of them have not been scientifically tested and are not recommended. The best device for you will be based on your history, examination and sleep study. Furthermore devices that are custom-fitted and adjustable are significantly more comfortable, durable and effective compared to the "over the counter" or "boil and bite" devices. The non-custom fitted devices are cheaper and tempting to trial. Unfortunately, they are quite uncomfortable and not a good indication on how a custom-fitted and adjustable device will feel. At the Perth Oral Medicine & Dental Sleep Centre we use 6 different device designs for various clinical scenarios.
What if I use dentures and have missing teeth, can I still use a device?
The newer devices can now be fitted against upper dentures and a minimum of 4 teeth on the lower jaw is required for adequate retention. Also these devices may be fitted on implants for good retention. Missing teeth and gum disease is not an absolute contraindication for the use of a mandibular advancement device.
Are these devices comfortable to use?
These devices are generally comfortable to use to bed and compliance among patients is good. Initially it can be a little uncomfortable as your jaw is postured forward. This discomfort typically resolves as you accommodate to the device with ongoing use. Occasionally, there may be sensitivity or soreness associated with teeth and gums which may be overcome with adjustments to the device.
Are there any side-effects?
The vast majority of patients have little or no side-effects. A small percentage of people have minor side-effects such as excessive saliva, jaw tenderness, pressure on teeth and bite changes. Most side-effects are temporary and disappear after a day or two or with simple adjustments. Long-term complications may or may not be fully reversible once therapy is discontinued. Given the potential for side effects and complications, it is recommended you seek the care of a specialist who is experienced in the field of Dental Sleep Medicine.
How long do these devices last?
These devices typically last 5 years. In some cases, the device may last longer if well maintained. In few cases, the device may break or deteriorate if a patient clenches and grinds their teeth during sleep. Most times, the device may be sent back to the dental laboratory for repair. Some manufacturers provide warranty on their devices for breakages and deterioration from customary use. The warranty ranges between 6 months and 3 years depending on the device.
Are mandibular advancement devices for snoring and obstructive sleep apnoea covered by private health insurance?
Yes, private health insurance rebates under dental cover do apply for these devices. You may choose to contact Perth Oral Medicine & Dental Sleep Centre for the relevant item numbers to check with your health fund.
What is involved in having a mandibular advancement device fitted at Perth Oral Medicine & Dental Sleep Centre?
At the first consultation you will undergo a thorough history, examination and discussion regarding the suitability of the device, potential side effects and expectation for successful use. If necessary, you may require radiological evaluation. After a lengthy discussion, if you choose to proceed with treatment, you will have impressions of your teeth (casts) and a bite registration to determine the optimal jaw position to design and fabricate a customised and adjustable device. Approximately 4 weeks later, your device will be fitted and you will be shown how to adjust it for maximum benefit. Also instructions on how to clean the device will be provided. The first review appointment to monitor your progress will be 4 weeks from the fit of the device and then irregular review appointments if necessary until the maximum benefit (such as improvement in snoring, tiredness and lethargy) of the device is achieved. Once your device has been titrated optimally, a treatment sleep study may be requested by your Sleep Physician to determine the objective efficacy (such decrease apnoea and increase oxygen saturation) of your device. At every appointment at Perth Oral Medicine & Dental Sleep Centre, your referring practitioner will receive a report detailing your progress.
Do I have to wear a device for life?
Not necessarily. There may be other methods, which you may utilise to help overcome the problem. For many patients weight loss, exercise or changing body position during sleep may be adequate to overcoming snoring and sleep apnoea. Compliance to behavioural changes can be challenging if you are sleepy and tired. Also, there are the options of trialling CPAP or having surgery.
Can I visit a general dentist for a mandibular advancement device?
The current guidelines state that oral appliances (mandibular advancement devices) should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the TMJ, dental occlusion and associated oral structures. Dental management of patients with oral appliances (mandibular advancement devices) should be overseen by practitioners who have undertaken serious training in sleep medicine and/or sleep related breathing disorders with focused emphasis on the proper diagnosis, treatment and follow-up. A major issue is the lack of training and experience among practitioners in the field of Dental Sleep Medicine, as this field is not typically covered in dental school curriculum.
Hence when choosing a practitioner, you should make the following 5 enquiries:
- Has your practitioner undergone formal post-graduate training in the field of Dental Sleep Medicine?
- Is your practitioner a specialist?
- Is your practitioner experienced and fabricates at least 100 devices yearly?
- Does your practitioner provide written reports back to your referring specialist at every appointment as required for good communication?
- Does your practitioner fabricate your device in a regulated Australia laboratory utilising reliable and safe materials rather than sending your records to an overseas laboratory for lower cost materials?