Based on over 40 years of published scientific studies, oral appliances are now designated by the Australian Sleep Association and American Academy of Sleep Medicine as a key treatment for snoring and sleep apnea.
Oral appliances are now also regarded by sleep physicians as the best available treatment for snoring and a main treatment for sleep apnea. At SleepWise Clinic we receive referrals for oral appliance therapy from specialist sleep physicians, GP’s, Ear Nose and Throat surgeons, dentists and other health professionals.
The appliances are made from thin yet high strength laminate hard soft materials, go over the tops of the teeth and are worn during sleep.
How does a oral appliance work to eliminate snoring and sleep apnea?
The main way that oral appliances work is by preventing the tissues at the back of the throat and the base of the tongue from collapsing back into the airway. These appliances take the lower jaw forward, bringing the tongue with it, thereby clearing the airway at the back of the throat.
How effective is an oral appliance?
There are now studies demonstrating that appliances are over 95% effective in overcoming snoring.
Effectiveness of oral appliances
A study at SleepWise Clinic*, involving 116 consecutive patients who have completed treatment, demonstrated that 111 were satisfied with the improvement in their snoring following the use of a customised, adjustable oral appliance. The majority of these patients had adapted well to their appliance and were feeling more refreshed on waking and less sleepy during the day.
*’Assessment of snoring with prescribed oral appliance’ August-October 2010
Associate Professor G Kennedy
PhD BBSc Grad Dip Mntl Hlth Sci (Clin Hypn) Dip Clin Hypn MAPS.
Types of oral appliances
Custom made oral appliances
The most effective, comfortable types of appliances are those made from impressions and models of the patient’s own teeth. These customised appliances ensure a perfect fit and can be made very thin and of minimal dimensions yet are still strong enough to last for many years.
State of the art appliances are not only custom made they are also adjustable This allows the dentist, and importantly the patient, to slowly bring the lower jaw forward to the ideal most comfortable position that opens the airway and overcomes the snoring and sleep apnea.
Finding the optimal oral appliance
There several custom-made oral appliances, all with different designs, that have good scientific studies proving effectiveness and comfort. There is no one appliance that is suitable for each and every person. The choice of an optimal oral appliance for an individual will depend on many factors including the number of teeth, the width of the dental arches of the palate and lower jaw, the degree of jaw protrusion, the size of the tongue, and the age of the patient.
SleepWise Clinic only uses state of the art custom made adjustable oral appliances for which there is good scientific evidence such as the following:
Apart from its very minimal design (only covering the tops of the teeth) the dorsal has a special design feature. It allows the jaws to open and close, so you can sip water and actually talk while it is in the mouth! Simple adjustments for bringing the jaw forward can easily be made by the patient -this is a key feature of a new generation appliance.
The silensor has the most wide spread use of any appliance in the USA. The components are metal free – made in Germany from high strength nylon. The latest version can be considered the most unobtrusive appliance available that still allows the patient to adjust the mandible forward.
The EMA Appliance
The EMA (Elastomeric Mandibular Advancement) is a small and unobtrusive sleep appliance. The upper and lower components are held together with straps of varying lengths and flexibility. These straps allow for excellent side to side movement, as well as dictating the amount of jaw advancement.
The MDSA appliance belongs to the group of appliances that have an anterior mechanism for bringing the jaw forward. A unique feature is the miniaturisation of the mechanism which provides maximal comfort and allows the jaw to move freely when connected.
The Herbst appliance allows for lateral and vertical movement and the components are extremely robust making it ideally suited to patients who clench and grind.
Important criteria in choosing a dentist for oral appliance therapy
- The dentist is experienced and trained in the field.
- The dentist utilises a range of state of the art oral appliances.
According to a recent survey conducted by the Australian Dental Association only four percent of dentists regularly provide oral appliances for the management of snoring and sleep apnea. Most dentists who make oral appliances only do so infrequently and it is only a small part of their dental practice, most of which is based on general dentistry.
The dentists at SleepWise Clinic are the most experienced in Australia having treated over 7000 patients with oral appliance therapy.
Dr Harry Ball, Dr Sam Talpis and Dr Ken Lee utilise the latest range of new generation oral appliances that have been scientifically proven to be effective and comfortable.
They work exclusively in this field and do not practice general dentistry.
Dental Sleep Lab
At SleepWise Clinic we have our own laboratory manufacturing oral appliances right here in Melbourne. Dental Sleep Lab is the only specialist dental laboratory in Australia manufacturing the full range of high quality, state of the art oral appliances.
The lab provides appliances not just for SleepWise Clinic but for other dentists throughout Australia who are working in the field. A huge advantage in having a laboratory at the clinic is that each and every appliance provided for a patient is well-fitting, comfortable and adjusted to the highest standards.
Benefits of Oral Appliance Therapy:
- You and your partner can look forward to a quiet night of sleep.
- No more embarrassing snoring sounds while travelling, camping or in any group situation.
- Wake up refreshed.
- Improved quality of life through greater vitality and participation
- Improved work performance due to greater concentration and energy levels.
- Decreased risk of fatigue-related vehicle and work accidents.
- Decreased risk of heart disease, stroke and blood pressure problems.
An Extra Benefit
Many people clench and grind their teeth during sleep and are unaware that this is occurring. This is a common cause of damage to teeth and dental work. Oral appliances have an added benefit of protecting teeth and dental work during sleep.
Unproven and ineffective treatments
Non prescription “over the counter” mouthguard devices
While custom-made oral appliances are proven to be effective, safe and comfortable, “over the counter”, non prescription devices, such as the Snore Ban, have now been banned from direct sale throughout the US. The US FDA has banned these devices because they are far less effective than custom-made adjustable oral appliances and because of the potential for side effects such as teeth movement and jaw joint damage. These devices are non-adjustable with one size fits all. Studies* demonstrate that such devices are far less effective than custom-made adjustable oral appliances. Available mostly for sale over the internet, not only do these devices have the potential to cause side-effects, they are difficult for people to wear – even in the short term.
A non-adjustable appliance makes it a guess to achieve the ideal forward position of the jaw and results in sub optimal outcomes. While such appliances are still used by some dentists, experts in the field are in general agreement that they should have no place in current clinical practice.
There are other treatments offered on the internet and in stores which include nasal strips, sprays, pillows, rings and breathing techniques. These methods are unproven and generally regarded as ineffective with some being the subject of ACCC investigations. These treatments are not recommended by sleep physicians and experts in the field.
*”Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea”
Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH.
American Journal of Respiratory & Critical Care Medicine. 2008 Jul 15;178(2):197-202.