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In some cases of snoring and obstructive sleep apnea, an oral appliance may be used for treatment. An oral appliance is an artificial (often plastic or acrylic) device similar in appearance to a mouth-guard [FIGURE 1]. The device is intended to be worn at night during sleep. By moving the lower jaw (mandible) forward, the appliance decreases the likelihood of the oral soft tissues collapsing and obstructing the airway. It is this obstruction that may contribute to snoring and OSA. A second type of oral appliance - a Tongue Retaining Device - applies suction to the tongue at night in order to keep it from falling back in the throat [FIGURE 2].
Unfortunately, many patients are unable to control their OSA with an oral appliance, and oral appliances have been found to be less effective than CPAP. As with CPAP, it appears that many patients find it difficult to tolerate oral appliances. Patient compliance rates seem to vary in studies, and have been reported to be as low as 25%.
The use of oral appliances may have associated complications. Commonly reported minor (often temporary) side effects have been noted to occur in up to 86% of patients. More severe and persistent complications have been noted to occur in up to 75% of patients. Complications/ adverse events include TMJ (temporomandibular joint) pain, myofascial pain, dental/tooth pain, tongue pain, dry mouth, gum irritation, severe gagging, excessive salivation, occlusal/bite changes, and TM joint sounds. |
