Pulmonary, Critical Care, and Sleep Medicine

Feb. 10, 2018

Since their first use in the early 1980s, oral appliances have become an increasingly popular treatment for obstructive sleep apnea (OSA). Sought after because of their relative ease of use and portability, oral appliances have proved efficacious in cases of mild to moderate OSA.

More recent research suggests that oral appliances can also improve important outcomes in selected patients with more severe disease. Newer innovations in oral appliance therapy include compliance recorders to help in long-term follow-up and emerging technologies to remotely adjust the appliance to optimize upper airway patency.

Dentists in Mayo Clinic Dental Specialties work closely with specialists in the Center for Sleep Medicine to provide an array of oral appliance options as part of a comprehensive treatment plan for patients with OSA. This past year, more than 240 oral appliances were custom-designed and dispensed.

What might a typical patient expect with this process?

SomnoDent Herbst telescopic oral appliance

SomnoDent Classic oral appliance

The patient undergoes an initial consultation to determine candidacy. Dental impressions are obtained and devices are ordered and manufactured at U.S.-based laboratories SomnoMed and Great Lakes Orthodontics. The finished product is typically delivered within four weeks, at which point fitting occurs and patients are educated on usage.

Most oral appliances are designed as mandibular advancers and are adjusted using a specialized tool. Gradual advancement over time reduces the potential for side effects such as discomfort of the jaw, muscles and teeth. Occlusal changes can gradually develop; most patients adapt to them over time. In general, at least eight teeth are needed on each arch to allow anchoring of the device. Temporomandibular joint dysfunction may not always be a contraindication to use of an oral appliance.

For those who don't have the minimum amount of teeth or cannot use a mandibular advancement device, a tongue stabilizing device is available. The device acts by tongue advancement by suction, thereby increasing the luminal diameter of the upper airway.

Calibration and efficacy of oral appliances are determined through a combination of symptom relief, clinical follow-up with both the dental and sleep medicine specialists, and objective sleep testing at the Center for Sleep Medicine, which may be as simple as overnight oximetry.