2014 AAO Winter Conf - Point: The Case for Oral Appliances in the Treatment of Sleep Disordered Breathing / Counterpoint: The Case for Maxillomandibular Surgery

Point: The Case for Oral Appliances in the Treatment of Sleep Disordered Breathing

Orthodontists, with their knowledge and training of functional appliances and established skills to evaluate jaw position, are ideally suited to provide oral appliance therapy in this field. Oral appliances have a direct effect on tongue posture during sleep and help to stabilize the mandible in a closed vertical position. These appliances are commonly regarded as a simple, silent, bed partner-friendly, less invasive, reversible, tolerable and efficacious choice and have been demonstrated to have a beneficial impact on a number of essential medical outcomes, including polysomnographic data, subjective and objective measurements of sleepiness, cardiovascular functions, neuropsychological behaviours and quality of life indices. Several factors appear to contribute to the effectiveness of oral appliancess – appliance design and titration, the severity of the sleep apnea, the amount of advancement, the vertical opening of the mandible, positional sleep apnea and the Body Mass Index (BMI). Oral appliances appear to work by enlarging the upper airway patency at multiple levels and by improving muscle airway tone and thus decreasing upper airway collapsibility.

Learning Objectives:

• Describe the indications, contraindications, advantages and disadvantages of the currently-available appliances in the field
• Illustrate how to titrate an adjustable oral appliance to achieve the maximum effectiveness for the treatment of snoring and/or OSA
• Relate the results of clinical trials designed to compare the effectiveness of specific oral appliances and how they might compare to nasal continuous positive airway pressure or surgical procedures