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Oral Appliance Therapy for Obstructive Sleep Apnoea

Guide for new users or patients who have been prescribed OAT by their sleep physician.

If you have not yet been diagnosed, or have not consulted any sleep or ENT specialist, please read here first

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Welcome. You may have just started your OSA journey and recently been diagnosed, or you may have had this condition for years and have already gone through surgery and CPAP.  You might be feeling frustrated and tired searching for solutions.

You are probably reading this because you have been referred by your sleep physician or ENT specialist for oral appliance therapy.  This is an accepted treatment for OSA, but due to poor public awareness, this may be the first time you have even heard of it.

Please read on to find out more as you embark on this treatment, to give you a better understanding of what it is, how it works and why so many patients are choosing this as an alternative to CPAP.

Sleep Medicine is a subspecialty of Medicine, just as Dental Sleep Medicine is of Dentistry. As an OSA patient it is important that you have access to sleep trained practitioners in every discipline (e.g ENT, orthodontists, oral surgeons, psychologists, psychiatrists, speech pathologists), should you require them. Through our networks of sleep-trained and sleep focused professionals, we ensure your condition is managed in the correct way, even while you are treated for other conditions.

 

 

OSA is a treatable condition, the key is to be aware of the options available. 

#advocateforyourhealth

WHAT IS ORAL APPLIANCE THERAPY FOR OSA? 

  • Otherwise known as a mandibular advancement device (MAD), it is also known as MRD, MAS, or OAT (oral appliance therapy)

  • It holds the jaw forward while you sleep, to prevent collapse and blockage of the airways.

  • It is a removable device, much like a denture or orthodontic plate 

  • It is non invasive, compact, portable, easy to clean and use. 

  • It is well tolerated in many patients and significantly reduces snoring.

  • It is not a "cure" for OSA. Much like wearing glasses, it only treats your condition when worn.

  • It is approved for treatment for mild to moderate obstructive sleep apnoea and also for severe patients who are unable to tolerate CPAP.

  • It is also very effective for pure snoring (for people who don't have OSA)

  • If you and your doctor decide that OAT is the best treatment option for you, your doctor will write you a prescription for a custom-made oral appliance.

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01

Custom fit appliance 

Your oral appliance will be custom made to fit your mouth perfectly. Dr Ng will need to ensure that your mouth is dentally fit to start oral appliance therapy and ensure your muscles and joints are functioning normally to be able to accommodate the movements required for successful treatment.

03

Range of products to suit all faces and jaws

Dr Ng utilises several different models of MAD and brands to be able to treat a wide range of patients with different skeletal structures and soft tissue considerations. Most of the differences between models are to do with the physical properties of the materials they are made of, and Dr Ng will be able to advise you which is best suited for your individual needs.

02

Closely guided support

You will be given clear and detailed instructions from the start of your treatment, and should you be confused or require clarification, don't hesitate to ask at anytime. We will be happy to answer any of your questions and give you the step by step support you need for successful therapy.

04

Strong and reliable materials

We are constantly monitoring product upgrades and improvements so as to provide our patients with the best possible approved and tested appliances on the market.  We offer appliances which are thinner for greater comfort and are metal, epoxy, BPA, BPS and latex free for patients with sensitivity to certain materials.  Feel free to touch and handle the appliances and get familiar with their unique mechanisms. 

The Process

Oral Appliance Therapy 

OAT stands for oral appliance therapy, and is an effective, non-invasive treatment option for snoring and OSA that fits easily into your lifestyle. An oral appliance called an MAD looks like an orthodontic retainer and is worn only during sleep. It supports the jaw in a forward position to help keep your upper airway stay open through the night, which prevents obstructive sleep apnoea events and snoring.

Dr Elaine Ng is trained to provide OAT, which is treatment with custom-fitted oral appliances. Patients take to it easily because it’s comfortable, easy to wear, quiet, portable, convenient for travel and easy to clean.

 

 

 

 

 

 

 


 

 

Treating snoring or sleep apnea with OAT can help you feel like a new person. Patients often find that their symptoms and quality of life can improve dramatically, when they remain committed to their treatment and use it nightly. Custom-fit oral appliances from can improve your sleep, restore your alertness, and revitalize your health.

 

 

GETTING STARTED

Once you have received the prescription from your ENT specialist or sleep physician for oral appliance therapy you may proceed to book your appointment.

FIRST CONSULTATION :  You will be assessed in your medical, dental and sleep history. You will also be given dental and sleep hygiene advice as appropriate.

Full records will be obtained and you will undergo a series of tests and examinations.

This is to ensure you are dentally fit for oral appliance therapy and to discover any potential issues which may hinder your treatment. First consultation is about 50-60min.

FACTORS WHICH CAN DELAY TREATMENT :

Patients who have pre-existing broken teeth, fillings or infections will need these issues treated first before we are able to fabricate an oral appliance.  Also patients who are in the midst of orthodontic, or implant surgery will only be able to start OAT after completion of their braces/aligner treatment or implant restoration.

The foundation is important, because healthy and strong supporting teeth are needed - a brand new house cannot be built on a weak foundation. Patients who have taken good care of their teeth, maintain good oral hygiene, and see their dentist regularly, are less likely to have any delays to their treatment.

SELECTION and SCANNING: 

Once you are declared dentally fit to proceed to fabricate your MAD, (which often can be the very same day as the initial consultation) - your own personal MAD will selected and designed according to your needs, and your teeth will be photographed and scanned using a digital scanner. This is painless and involves inserting a scanning device into your mouth which shines a light on the teeth much like a camera.

HOW DO I KNOW WHICH BRAND TO CHOOSE?

Based on your soft tissue profile and face shape, Dr Ng will help you select the most ideal design for you, taking into account your own preferences for hygiene, fit and appearance.

FIT and ISSUE:

You will be asked to return for issue of the MAD and be taught how to use and maintain it. You will be given instructions and a guide on how to adjust your appliance and will start the titration process - this is the adjustment of your appliance according to your symptoms.

Symptoms such as snoring, choking, gasping, cessation in breathing, daytime tiredness, difficulty concentrating, and waking up to go to the toilet in the night should be reduced once wearing your MAD at its optimal settings.  

For patients who do not have a bed partner who can give feedback on their snoring or breathing pauses, patients can also download snoring apps on their phones such as SnoreLab to help monitor improvements in snoring loudness and frequency.

Fit and issue appointment is about 30min.

You must return 4 weeks after issue of your appliance to complete the titration process.  

This is key to ensure success of your appliance treatment

REVIEW APPOINTMENTS:

4 weeks - you will be reviewed to check on your oral and appliance hygiene, and resolution of your symptoms.

Subjective and objective tests will be carried out to check for efficacy of your treatment, and your sleep specialist/ENT specialist will be updated accordingly.

Once we have identified the correct setting for your appliance, and you are wearing it comfortably at night, you will be reviewed 6 monthly for the 1st year, then yearly thereafter.

 

Please continue to see your sleep specialist/ENT should they require you to attend reviews concurrently.  You must also continue to see your own general dentist and hygienist to maintain the health of your teeth.

WHAT ELSE SHOULD I KNOW?

SIDE EFFECTS?

Every treatment has potential side effects and oral appliances are no different.

Initially some patients may experience the following: 

  • excessive salivation

  • dry lips

  • dry throat

  • soreness of the teeth and/or jaws

  • joint clicking

  • joint pain

 

Studies have shown that these side effects are mostly transient, and most occur within the first two years of regular use, and resolve without any treatment.

Permanent changes to the bite may occur in certain patients, and the likelihood increases with number of years and hours of wear (Noted* CPAP masks which rest on the upper lip are also documented to case permanent changes to the upper front teeth).  However, the medical risks of not treating OSA far outweigh the dental side effects of shifting teeth, hence most patients do not mind, and often do not even notice the difference. 

We do advise that patients comply to our instructions when using their MAD, which can help to minimise these risks as much as possible.  We ensure tight control over your oral condition with accurate diagnostics and baseline recordings to help you maintain your oral health.

Patients should follow instructions carefully and mindfully, as well as return for all review appointments - these are major factors that affect your treatment success.

WHAT HAPPENS IF MAD TREATMENT DOESN'T WORK FOR ME?

Not every treatment is suitable for every patient.

Some patients are able to take to CPAP immediately with no problems, and others are unable to tolerate even one night.

Fortunately, many studies show that MAD treatment is much better tolerated than CPAP and most patients are able to wear it without any major problems. Efficacy may not be as high in certain patients, and these less responsive individuals have been identified through research as:

- higher BMI

- more severe OSA 

- greater neck circumfrence (usually higher than 16")

In addition, there are certain lifestyle factors and medications that will hinder the efficacy of treatment.

These include drinking alcohol before sleeping, use of sleeping pills, opiates and muscle relaxants.  These cause the airway to become even "floppier" than normal, which leads to more obstruction of the airway.

 

CAN I TRY OUT MAD?

Unlike a CPAP,  the MAD is custom made for each patient, and are not able to be rented or borrowed to "try-out". 

AADSM GUIDELINES

AADSM guidelines advise patients with severe OSA who are intolerant of CPAP,  to be prescribed MAD by their doctors because it is better than not treating their OSA at all.

MODES OF WEAR

Studies have also shown greater reduction in OSA events with combination therapy - wearing of MAD + CPAP at lower, more tolerable air pressure settings.

Some patients wear MAD as an alternative to CPAP when they go on holiday, or travel for work.  Others wear MAD on weekdays and CPAP on weekends.

It is all about finding the effective combination that is comfortable for you to treat your condition long-term.

If you have concerns about snoring and sleep apnea, contact us for an appointment today!  Dr Ng will be happy to answer your questions about obstructive sleep apnea and oral appliance therapy. 

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