257:, dental discomfort and jaw pain. Long-term use is not associated with temporamandibular disorders but was associated with permanent changes in how the upper and lower teeth meet, and the appliances needed about 0.8 repairs/relines per year. Some patients can find these devices somewhat uncomfortable, although many patients find them less bothersome than CPAP mask treatment, so patients are more likely to wear them consistently and comply with treatment CPAP manufacturers claim that improperly fitted devices may cause teeth to shift over time, like with CPAP, but cite no evidence to support these claims. Patients may pay around $ 1900 out of pocket to secure these devices, and, in the US, some health plans do not cover these costs. The high price for prescription devices has led to a proliferation of lower cost non-prescription devices that are unproven and some sleep specialists suggest may be dangerous.
237:(CPAP) devices in lowering the blood pressure of patients with OSA. The medical dental sleep appliance, or MDSA, was clinically proven to conclusively show in a large and complex randomized controlled study that CPAP and MAS are effective in treating sleep-disordered breathing in subjects with AHI 5–30. CPAP was thought to be more effective, but randomised control evidence (such as that reviewed in 2013) suggests splints may be as effective in patients with a range of severities of obstructive sleep apnoea. Both methods appear effective in alleviating symptoms, improving daytime sleepiness, quality of life and some aspects of neurobehavioral function, with CPAP usage being less than self-reported MAS usage. More test subjects and their domestic partners felt that CPAP was the most effective treatment, although MAS was easier to use. Nocturnal systemic
181:. According to the current American Academy of Sleep Medicine treatment guidelines, oral appliances should be considered for patients with snoring or minor to moderate sleep apnea, or as an alternative to CPAP in non compliant patients with severe obstructive sleep apnea. Where appropriate, they are considered a good therapy choice as they are non-invasive, easily reversible, quiet, and generally well accepted by the patient. The focus of improvement in appliance design is in reducing bulk, permitting free jaw movement (permitting
37:
154:
146:
272:
137:(2008) researched prescription custom-made splints head-to-head with thermoplastic over-the-counter splints: "Our results suggest that the thermoplastic device cannot be recommended as a therapeutic option nor can it be used as a screening tool to find good candidates for mandibular advancement therapy."
169:
The splint treats snoring and sleep apnea by moving the lower jaw forward slightly, which tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep. The tightening created by the device also prevents the tissues of the upper airway from vibrating as
221:
They are generally more successful at treating mild and moderate sleep apnea and less effective at treating severe sleep apnea, even though good success was measured even in severe sleep apnea. They may bring the level of apnea a patient experiences down significantly but fail to eliminate it.
192:
Evidence is accumulating to support the use of oral devices in the treatment of OSA, and studies demonstrating their efficacy have been underpinned by increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA. Oral devices have been shown to have beneficial
376:
Vanderveken, Olivier M.; Devolder, Annick; Marklund, Marie; Boudewyns, An N.; Braem, Marc J.; Okkerse, Walter; Verbraecken, Johan A.; Franklin, Karl A.; De Backer, Wilfried A. (2008-07-15). "Comparison of a Custom-made and a
Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea".
614:
Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, Marks GB, Cistulli PA (April 2013). "Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial".
121:
The
American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommend that sleep physicians should prescribe sleep apnea oral appliances for adult patients who need treatment for their primary
217:
surgeons and sleep physicians to treating OSA. The study suggests that higher levels of NAR may negatively affect outcome with MAS and subsequently methods to lower nasal resistance may improve the outcome of oral device treatment.
205:
functioning, and quality of life. Elucidation of the mechanism of action of oral devices has provided insight into the factors that predict treatment response and may improve the selection of patients for this treatment modality.
165:
was used to map a patient's mouth. The output tube has two separate airways that allow air to flow through to the back of the throat, avoiding obstructions from the nose, the back of the mouth and tongue.
650:
Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ (September 2004). "Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea".
538:
Haviv Y, Bachar G, Aframian DJ, Almoznino G, Michaeli E, Benoliel R (April 2015). "A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study".
957:
Haviv Y, Zini A, Almoznino G, Keshet N, Sharav Y, Aframian DJ (July 2017). "Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea".
260:
Adherence to oral appliance is strongly associated with patient reservations regarding the effects of the device on teeth, possible lack of efficacy, and discomfort.
850:
Glos M, Penzel T, Schoebel C, Nitzsche GR, Zimmermann S, Rudolph C, Blau A, Baumann G, Jost-Brinkmann PG, Rautengarten S, Meier JC, Peroz I, Fietze I (May 2016).
249:
In a survey study of patients, many discontinued use because of discomfort, lack of efficacy or switching to CPAP, and frequent side-effects such as
213:
on the influence of nasal resistance (NAR) on oral device treatment outcome in OSA demonstrates the need for an interdisciplinary approach between
1007:
575:"CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis"
234:
127:
93:
329:"Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015"
126:(without obstructive sleep apnea) rather than no treatment and for patients who have obstructive sleep apnea but are intolerant to
687:"Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome"
925:
290:
233:
investigating the effects of CPAP and oral devices on blood pressure found that oral devices were equally effective as
230:
785:"Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications"
1002:
194:
85:
451:
852:"Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime"
442:
Chan AS, Lee RW, Cistulli PA (August 2007). "Dental appliance treatment for obstructive sleep apnea".
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489:"Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea"
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Martínez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C (January 2010).
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Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, Ryan F (April 2005).
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Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD (July 2015).
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736:"Dental side effects of an oral device to treat snoring and obstructive sleep apnea"
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was shown to improve with MAS but not CPAP, although the changes are small.
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900:"Managing a Sleep Disorder Long-Term: Will Insurance Cover Your Expenses?"
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Zeng B, Ng AT, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2008).
344:
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Rose E. (2004). "Identifying the Ideal Oral
Appliance Candidate".
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used to treat sleep-related breathing disorders including:
926:"Over-the-counter devices probably won't help sleep apnea"
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American
Journal of Respiratory and Critical Care Medicine
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of OSA, subjective and objective measures of sleepiness,
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is a prescription custom-made medical device worn in the
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Bratton DJ, Gaisl T, Wons AM, Kohler M (December 2015).
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air passes over them—the most common cause of snoring.
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Mandibular advancement splints are widely used in the
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effects relating to several areas. These include the
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from titanium coated with a medical grade plastic. A
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149:A different style of mandibular advancement splint
41:A mandibular advancement splint for treatment of
734:Pantin CC, Hillman DR, Tennant M (March 1999).
130:therapy or otherwise prefer alternate therapy.
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177:and are beginning to be used in the
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96:. These devices are also known as
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422:Journal of Orofacial Orthopedics
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157:A mandibular splint produced by
924:Woolston, Chris (2011-02-28).
291:Oral and maxillofacial surgery
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652:Am. J. Respir. Crit. Care Med
617:Am. J. Respir. Crit. Care Med
78:mandibular advancement splint
30:Mandibular advancement splint
1008:Treatment of sleep disorders
231:randomized controlled trials
105:sleep apnea oral appliances
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664:10.1164/rccm.200311-1571OC
629:10.1164/rccm.201212-2223OC
209:A 2008 study published in
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391:10.1164/rccm.200701-114OC
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195:polysomnographic indexes
592:10.1001/jama.2015.16303
86:obstructive sleep apnea
753:10.1093/sleep/22.2.237
507:10.1093/sleep/31.4.543
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18:Mandibular advancement
466:10.1378/chest.06-2038
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296:Orthognathic surgery
109:oral airway dilators
101:advancement devices
203:neuropsychological
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971:10.1111/odi.12633
930:Los Angeles Times
704:10.5664/jcsm.8978
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943:2016-08-06
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187:gum shield
163:3D scanner
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