Oral Appliances


How they work and help:


Worn in the mouth during sleep, oral appliances are devices that reposition the jaw and tongue, helping to keep the airway open.  The slightly forward position of the jaw tonse the muscles that support the airway, keeping it open so that air can pass freely without obstruction.  Oral appliances are designed to maintain an open and unobstructed airway during sleep.


 Oral appliances have been proven to have equal efficacy in the treatment of mild and moderate obstructive sleep apnea as the CPAP.  The CPAP is the standard of treatment for severe obstructive sleep apnea.  However, for those patients with severe obstructive sleep apnea that either refuse to use a CPAP or are CPAP intolerant, an oral appliance is an acceptable method of treatment.  Studies suggest that patients prefer oral appliances therapy (51%) over CPAP (23.1%).  The increase patient compliance with oral appliances also allows for an increase in overall treatment effectiveness.


 Advantages of Oral Appliances:


-  Custom fit

-  Posterior support to protect the TMJ

-  Helps to manage grinding and clenching  (Sleep Bruxism)

-  Allow for freedom of movement of the lower jaw

-  Allow for increased nasal breathing

-  Adjustable to accommodate new dental work

-  Small and convenient for traveling

-  Effective and well tolerated by the patient


Oral Appliance Therapy:


In order to begin Oral Appliance Therapy,  the patient needs to have a diagnosis of obstructive sleep apnea, made by a board certified sleep medicine physician.    A polysomnogram (sleep study) or a home sleep test is needed to make a diagnosis of OSA (obstructive sleep apnea).  Dr. Firtel maintains close communication with both the sleep medicine physician and the patient's primary care physician to ensure comprehensive and coordinated treatment of the patient's sleep related breathing disorder.  Should a patient be a habitual snorer and not have obstructive sleep apnea, an oral appliance can still be made to manage the snoring.


Once a diagnosis for obstructive sleep apnea has been made, the steps of Oral Appliance Therapy are as follows:


1. Dr. Firtel at Pacific Coast Dental Sleep Medicine will examine your teeth, mouth,
and airway to determine if an oral appliance is right for you. If an oral appliance is
found to be the best treatment  for you, the optimal one will be selected.


2. Dental impressions will be taken and then the custom oral appliance will be fabricated, fitted, and adjusted to maximize its effectiveness.


3. Diagnostic tests are performed after you are using the appliance on a regular basis (approximately 4-6 months after initial delivery) to objectively measure the effectiveness of the oral appliance.


4. Yearly follow up appointments in order to maintain and ensure the comfort of the oral appliance.


5. Dr. Firtel will continue to work with the sleep apnea patient to help facilitate any life style changes such as diet, exercise, and sleep hygiene.


Choosing an oral appliance:


Dr. Firtel at Pacific Coast Dental Sleep Medicine offers several oral appliances in order to help you achieve a quiet, restorative, and restful night's sleep.  Specific conditions and factors that Dr. Firtel will consider when suggesting an oral appliance are:


 -  patient's bite

 -  size of tongue and soft palate

 -  presence of clenching or grinding (sleep bruxism)

 -  range of motion of the lower jaw (mandible)

 -  health of gums and teeth


 The following are examples of some of the appliances that may be chosen:


Herbst: The Herbst Appliance is one of the most common obstructive sleep apnea appliances.  It consists of two sturdy acrylic trays, one for the upper arch and one for the lower arch.  Each tray is made to fit firmly over the teeth.  They are connected by two bars which maintain the desired forward position of the mandible, comfortably opening the airway, and increasing the upper airway volume.  The Herbst sleep apnea appliance also allows for lateral and vertical movement of the jaw and can be adjusted to accommodate any future dental work.  The Herbst also provides posterior support of the jaw to protect the TMJ and help manage grinding and clenching, while providing adequate tongue space.


EMA appliance:  The EMA appliance consists of a lower and upper tray connected by two two flexible bands, one on either side of the appliance.  The bands come in different lengths and flexibilities, depending on the desired amount of mandibular advancement and lateral movement.  The various flexibilities of the bands allow for a high degree of customization of the appliance.  The EMA appliance helps keep the airway open by preventing the jaw and tongue from falling back and blocking the airway during sleep.  It also helps to protect the TMJ and manage grinding and clenching.


SomnoDent MAS: The SomnoDent MAS appliance have both an upper and lower tray.  It has a unique fin-coupling component that allows for normal vertical opening of the jaw while wearing the appliance.  The fins on the lateral aspect of the lower tray can be adjusted to maintain and control the advancement of the lower jaw.  The forward position of the mandible tightens and tones the muscles of the upper airway, helping to keep the airway open.




Oral Appliances


EMA appliance

SomnoDent MAS

Pacific Coast Dental Sleep Medicine     PHONE  858.453.8520     ADDRESS 3222 Governor Drive   San Diego, CA 92122    EMAIL info@pcdsm.com