Minimizing mandibular advancement in oral appliance therapy

In a recent study from the journal Sleep Medicine researchers looked at the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA). There is currently no gold standard method to fine-tune the mandibular advancement. This study was created to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea.

What were the results?

The researchers proposed the use of a multiparametric titration protocol to optimize the mandibular advancement. Thirty percent of the sample population exhibited the best results without any mandibular advancement and low frequency of side effects were observed. There were 36 patients involved in this study (22 were men) with a mean age of 57 years.

The mean mandibular advancement was between 1.7 and 1.5 mm achieving about 50 percent reduction in AHI in 72 percent of the patients. There were also 27 patients with an AHI of 10. Of the 21 patients with moderate to severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement of about three millimeters.

Researchers found that monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for proper treatment of OSA. What are some other ways to help improve oral appliance therapy results with our patients?

Why don’t more sleep physicians recommend oral appliances for OSA?

It’s an important question that many of us continue to wonder about – why aren’t more sleep physicians recommending oral appliances for sleep apnea? Well, to begin with, there appears to be a lack of data on the subject. While most dentists understand the importance of using oral appliances for the treatment of sleep apnea, physicians are still not in the know. So let’s get them some data.

What information is out there?

After doing a quick search through Google Scholar I found the following studies that showcase how effective oral appliances are for the treatment of sleep apnea in our patients:

Another reason is because they may not be comfortable with the process. If that is the case, then we must help them get more acquainted. This can be done by contacting their offices and educating them on the services we provide. Through proper education and understanding, you can help sleep physicians become better acquainted with oral appliance therapy as a successful alternative to the CPAP machine.

They are ignorant about topics they know little about, which is why it is important to educate them on oral appliances. Look up studies, attend classes and do what you can to provide the information they need to better understand this treatment alternative so we can all continue to help patients get a better night’s sleep.