Dental Sleep Medicine & Oral Appliance Therapy

Understanding Oral Appliance Therapy (OAT)

In dental sleep medicine, Oral Appliance Therapy (OAT)—specifically Mandibular Advancement Devices (MADs)—works through a combination of mechanical repositioning and neuromuscular activation. The primary objective is to help prevent collapse of the upper airway during sleep.

How it works

1. Mechanical airway expansion

   The appliance stabilizes the lower jaw (mandible) in a slightly forward and downward position to support an open airway.

   • Mandibular–tongue connection: Advancing the mandible creates forward traction on the genioglossus muscle, moving the base of the tongue away from the back of the throat.
   • Lateral expansion: Imaging studies (MRI/CT) show the greatest increase in airway volume often occurs laterally due to tensioning of surrounding soft tissues as the mandible moves forward.
   • Soft palate tensioning: Forward mandibular positioning can help stabilize the soft palate and reduce vibration (snoring) or collapse.

2. Prevention of “passive” collapse

   During REM sleep, muscle tone drops and the jaw can fall backward, narrowing the airway. The appliance acts like a mechanical “splint,” keeping the jaw in a stable position even when muscles relax.

3. Neuromuscular activation

   Research suggests the presence of the appliance may stimulate airway dilator muscles, helping increase resting tone or triggering reflexes that keep the airway more rigid during breathing.

Why patients choose OAT

For many people, the decision comes down to a balance between efficacy (how well it works in ideal conditions) and effectiveness (how well it works in real life).

• Real-world adherence (Mean Disease Alleviation): While CPAP can be extremely effective when worn, many patients struggle to use it consistently. Oral appliances are often more comfortable, which can lead to higher nightly adherence.
• Clinical indications: OAT is commonly recommended for primary snoring, mild-to-moderate OSA (especially if the patient prefers it), and for severe OSA when CPAP cannot be tolerated.
• Systemic health outcomes: Effective treatment can support better cardiovascular metrics (like blood pressure), reduce daytime sleepiness, improve quality of life, and lower risks related to drowsy driving.

The mechanism & benefits (quick overview)

• Mechanism: A custom mandibular advancement splint gently brings the lower jaw and tongue forward to help maintain an open airway.
• Benefits: Silent, non-invasive, travel-friendly, no electricity or hoses required (unlike CPAP).

The Collaborative Workflow (Step-by-Step)

This approach clarifies the dentist’s role versus the physician’s role and ensures your treatment is both appropriate and verified.

1. Initial screening: We identify symptoms (snoring, daytime fatigue) and perform a clinical airway evaluation.
2. Physician diagnosis: We refer you to a board-certified sleep physician for a sleep study (PSG) or a Home Sleep Apnea Test (HSAT). A dentist cannot diagnose OSA.
3. Treatment selection: Once diagnosed, the physician determines whether OAT is appropriate as a primary treatment or as an alternative for CPAP intolerance.
4. Custom fitting: Digital impressions (e.g., iTero/3Shape) and precision fitting of your device.
5. Follow-up & verification: Ongoing titration and a follow-up sleep study with the appliance in place to confirm efficacy.

CPAP Intolerance: You Have Options

A high percentage of patients struggle with CPAP compliance. Oral Appliance Therapy is a clinically proven alternative for mild-to-moderate OSA, and can also be appropriate for severe cases when CPAP cannot be tolerated.

Appliance selection & technology

We use efficient, highly accurate digital workflows and FDA-cleared, medical-grade devices (including options such as SomnoMed, ProSomnus, or Panthera) tailored to your anatomy and clinical history.

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