Sleep Apnea

Treatments for Obstructive Apneas, Jaw Retainers

Posted on 18. Dec, 2009 by admin in Treatments for Obstructive and Mixed Apneas

Another type of oral device that has been tested in several laboratories and sleep clinics is a jaw retainer, also called a mandibular advancement device (MAD). These are dental appliances that hold the lower jaw forward.

Jaw retainers look like the bite plates or retainers that sometimes are prescribed by orthodontists. They are made of dental acrylic and may have metal loops over several teeth to hold the device in place (Figure 7.6).

Many different manufacturers have designed their own version of a jaw retainer. Some models are adjustable for easy selection of the best forward position for the lower jaw. Most jaw retainers must be custom-fitted.

Definitive studies to pinpoint who will benefit from a jaw retainer or which devices work best have not been completed. Studies of mandibular appliances in sleep apnea patients have used small numbers of patients and different definitions of “success.” So far these limited clinical trials suggest that mandibular devices are about 50 percent effective. That is, about 50 percent of patients who try them still have serious enough sleep apnea symptoms that they need additional treatment. The adjustable models may be more practical than models that are not adjustable. It is unlikely that any one design will work equally well for all patients.

For these and other reasons, people who are considering an oral appliances would be wise to consult a dentist who is experienced in using these devices and who works in cooperation with a sleep specialist. The sleep specialist (not the dentist) should make the diagnosis of obstructive sleep apnea and should measure the effectiveness of the dental device after the dentist has fit the patient with it. You can locate a dentist near you who has been trained in this field by contacting the Sleep Disorders Dental Society.

Who Can Benefit from Using a Jaw Retainer?
The manufacturers of jaw retainers and some experimenters who have patients using them have reported some good results, especially in patients who have mild to moderate apnea.

Because jaw-retaining devices concentrate their treatment on the lower jaw and/or tongue, people with a smallish lower jaw that is set somewhat far back (called by orthodontists a class II occlusion) are likely to have good results.

Retainers also have been used successfully in children born with irregularly formed jaws who have difficulty with obstructive apnea.

Three-quarters of people with sleep apnea have airway obstructions in more than one place. People whose obstructive apnea results mostly from nasal problems or from the upper pharynx (large tonsils, adenoids, soft palate, uvula) are not likely to be treated successfully with an oral device and will need further treatment. In fact, you must be able to breathe through your nose to use the retainer; a person with a nasal obstruction or a stuffy nose from an allergy or a cold will be unable to wear one. Even some people who seem likely candidates for a jaw retainer continue to have apnea events, as shown by heavy snoring. Also, it is necessary to have an adequate number of teeth to be able to hold an appliance in place.

One group of people who may want to try an oral appliance are those who have been unable to use CPAP despite a wholehearted effort. If a nasal obstruction is preventing you from successfully using CPAP, it also will prevent you from using an oral appliance. If you can eliminate the nasal obstruction (by surgery or medication), you may then be able to use CPAP.

There may be a place for occasional use of an oral device, even if it is only partially effective, for example:

1. When CPAP is unavailable (backpacking, primitive travel);
2. When the device allows the patient to use a lower CPAP pressure; and
3. When screening patients for mandibular advancement surgery (to simulate the possible results of surgery).

Objective studies of the benefit in these situations are not yet available.

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Tags: Jaw Retainers, Obstructive Apneas, Treatments