I already have a dental splint. Will this treat my sleep apnoea?

A splint and a mandibular advancement appliance are very different oral appliances. They treat different conditions. A splint is usually used to assist in the treatment of tooth grinding, jaw clicking and/or jaw pain. Some splint designs may actually exacerbate snoring. A mandibular advancement appliance is specifically use to treat snoring and/or sleep apnoea. It may also assist in reduction of tooth wear due to grinding as the teeth are usually covered by the appliances.

I am so happy that my snoring is gone with my mandibular advancement appliance! How do I know that it is helping my sleep apnoea?

There is scientific evidence that these oral appliances work. However, whether the appliance 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 appliances as first line therapy for snoring and mild to moderate obstructive sleep apnoea. These appliances may also be used in patients with severe obstructive sleep apnoea who refuse or cannot tolerate CPAP. The only sure way to know that the appliance is helping your sleep apnoea is to have a treatment sleep study – where you wear it during the sleep study so the results can be analysed to assess its effectiveness.

I found CPAP too hard to travel with. Can a mandibular advancement appliance be used instead?

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 appliance may be used for snoring and mild to moderate obstructive sleep apnoea. Also a mandibular advancement appliance may be used if you elect not to use CPAP or cannot tolerate CPAP. A mandibular advancement appliance can be easily carried in your pocket and hence easy to use when travelling. Also, it is convenient when there is no access to power to use CPAP.

How do these appliances work to help my snoring and sleep apnoea?      

These appliances work 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).

The mandibular advancement appliance I had made at Perth Oral Medicine and Dental Sleep Centre is more comfortable compared to the one I got from the pharmacy! Why didn’t the pharmacy appliance fit as well?

There are over 100 appliances available on the market. Most of them have not been scientifically tested and are not recommended. The best appliance for you will be based on your history, examination and sleep study. Furthermore, appliances that are custom-fitted and adjustable are significantly more comfortable, durable and effective compared to the “over the counter” or “boil and bite” appliances. The non-custom fitted appliances are cheaper and tempting to trial. Unfortunately, they are quite uncomfortable and not a good indication on how a custom-fitted and adjustable appliance will feel. At the Perth Oral Medicine & Dental Sleep Centre, we have 6 different appliance designs for various clinical scenarios.

I am so glad that I was able to have a mandibular advancement appliance made, even though I have a denture. Will it work for someone who has missing teeth but does not wear a denture?

The newer appliances can now be fitted against upper dentures and a minimum of 4 teeth on the lower jaw is required for adequate retention. Also, these appliances may be fitted on implants for good retention. Missing teeth and gum disease are not absolute contraindications for the use of a mandibular advancement appliance.

How long does it usually take to get used to a mandibular advancement appliance?

These appliances 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 appliance with ongoing use. Occasionally, there may be teeth and gum sensitivity or soreness which is typically overcome with adjustments to the appliance.

It took me a couple of weeks to get used to my appliance. Should I expect any other side-effects?

The vast majority of patients have little or no side-effects. A small percentage of patients 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 to the appliance. 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 clinician at Perth Oral Medicine and Dental Sleep Centre who is experienced in the field of Dental Sleep Medicine.

I’ve been wearing my mandibular advancement appliance for a year now, and it has been great! How long will I be able to continue to use the same appliance?

These appliances typically last 5 years. In some cases, the appliance may last longer if well maintained. In few cases, the appliance may break or deteriorate if a patient clenches and grinds their teeth during sleep. Most times, the appliance may be sent back to the dental laboratory for repair. Some manufacturers provide warranty on their appliances for breakages and deterioration from customary use. The warranty is typically 1 year depending on the appliance.

Are mandibular advancement appliances for snoring and obstructive sleep apnoea covered by private health insurance?

Yes, private health insurance rebates under dental cover do apply for these appliances. 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 appliance 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 appliance, potential side effects and expectation for successful use. If necessary, you may require radiological evaluation. Following 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 appliance. Approximately 4 weeks later, your appliance will be fitted, and you will be shown how to adjust it for maximum benefit. Instructions on how to clean the appliance will be provided.  The first review appointment to monitor your progress will be 4 weeks from the fit of the appliance and then irregular review appointments if necessary, until the maximum benefit (such as improvement in snoring, tiredness and lethargy) of the appliance is achieved. Once your appliance has been titrated optimally, a treatment sleep study may be requested by your sleep physician to determine the objective success (such decrease apnoea events and increase oxygen saturation) of your appliance. At every appointment at Perth Oral Medicine & Dental Sleep Centre, your referring doctor will receive a report detailing your progress. It is important that the appliance is checked at least every 12 months whilst you wear it, to ensure that any potential side effects can be minimized.

Building a healthy environment that supports development for the community. Your personal case manager will ensure that you receive the best possible care.

Jonathan Steve

Healthcare Plan

Dental Implant

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