The Orthodontist's Role in the Treatment of Snoring and Obstructive Sleep Apnea

Orthodontists, with their knowledge 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. Several factors appear to contribute to the effectiveness of oral appliances – appliance design and titration method, 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. The advantages and disadvantages of four different oral appliance titration techniques will be discussed to facilitate better utilization of oral appliances in dental sleep medicine.

Learning Objectives:

• Describe the indications, contraindications, advantages and disadvantages of the currently-available oral appliances used in the field.
• Outline how to titrate an adjustable oral appliance to achieve the maximum effectiveness for the treatment of snoring and/or OSA.
• Discuss 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.