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Oral appliance therapy

An oral appliance is a custom fitted device worn at night that holds the lower jaw slightly forward, keeping the airway open. It treats snoring and mild to moderate obstructive sleep apnea, and is often used by people who cannot tolerate a CPAP machine. It is made from impressions of your teeth and adjusted over several weeks.

How it works

During sleep the tongue and soft tissues fall back and narrow the airway. An oral appliance holds the lower jaw a few millimetres forward, which carries the tongue forward with it and keeps the space behind it open.

It is worn only at night. It is not a mouthguard and it is not the device sold in pharmacies: it is made to your teeth and adjusted in small controlled steps.

Who it is for

  • People who snore heavily, with or without diagnosed apnea
  • People with diagnosed mild to moderate obstructive sleep apnea
  • People with any severity of apnea who cannot tolerate CPAP
  • People who travel constantly and will not carry a machine

It is not the first choice for severe apnea, where CPAP remains the better treatment. See snoring and sleep apnea for where the boundary sits.

How the treatment runs

  1. Assessment, including your sleep study result if you have one, and an examination of your teeth, gums and jaw joint. Enough healthy teeth are needed to hold the appliance, and active gum disease has to be dealt with first.
  2. Impressions and a bite record, which set the starting jaw position.
  3. Fitting, usually two to three weeks later, with instruction on how to insert, remove and clean it.
  4. Titration. Over the following weeks the advancement is increased in small steps until snoring settles and you feel rested. This gradual part is what a pharmacy device cannot do.
  5. Confirmation. Where apnea was diagnosed, a repeat sleep study with the appliance in place confirms it is working.
  6. Review, ongoing, to check the fit, the bite and the jaw joint.

The honest downsides

Extra saliva at first. Morning jaw tenderness for the first couple of weeks. A risk of slow changes to the bite over years of use, which is why the reviews exist. And it needs wearing every single night to do anything at all.

Dr. Diala's training in this

Seven months studying dental sleep medicine with the American Academy of Dental Sleep Medicine, and time in the pulmonary department at CMC. This is not a service added because it is fashionable. More about her background.

Questions people ask

Yes, and anyone who tells you otherwise is not being straight with you. Small changes to the bite and tooth position happen in a proportion of long term users. They are usually minor and slow, we check for them at every review, and there are morning exercises that reduce them. It is a genuine trade-off against untreated apnea.

For severe apnea, no. CPAP is more effective when it is used. For mild to moderate apnea the gap is much smaller, and for someone who cannot tolerate CPAP the comparison that matters is between an appliance worn nightly and a machine not worn at all.

No, and those are worth avoiding. A boil and bite device fits nobody properly, cannot be adjusted in controlled increments, and can load your jaw joint badly. This is made from impressions of your teeth and titrated over weeks against how you actually sleep.

Odd for the first week or two. Expect extra saliva at first, and some tenderness in the jaw muscles in the morning that eases within twenty minutes. Most people who get past the first fortnight stop noticing it. If jaw pain persists rather than settling, tell us, because the advancement can be reduced.

Yes. Diagnosis comes from them, and where apnea has been diagnosed a follow up study with the appliance in place is how you confirm it is actually working. Feeling better is encouraging but it is not the same as evidence, and this is the part people skip.

Appointments

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