Mr Simon GS Ellis

BDS, MSc, FDS FDS(Rest Dent) RCSEd

Specialist in Prosthodontics, Endodontics, Periodontics & Restorative Dentistry

Consultant in Restorative Dentistry, Torbay Hospital, Torquay

__________________________________________________________________________________________

Snoring is a sign of partial upper airway obstruction during sleep whilst Obstructive Sleep Apnoea is, as the name suggests, an obstruction of the airway.  Snoring and OSA are caused by abnormal airway anatomy (between the base of the tongue and soft palate) and altered respiratory control mechanisms.

Dental appliances MAY prevent snoring and OSA by modifying the position of the upper airway structures so as to enlarge and/or reduce collapsibility of the airway.  There are many different types of dental appliances although the consensus appears to be a type of Mandibular Repositioning Appliance (MRA), which repositions the lower jaw in a forward and down position to open up the airway at the back of the mouth. It is important to know that MRAs do not always work.  Success rates vary between 50-90% and depend on factors such as diagnosis, severity of the disorder and more critically on the scoring value for success in studies (as success in one study would not be considered a success in another!) and patients actually wearing them (some patients cannot tolerate them).  

Different types of appliances.  The durable and adjustable hard acrylic MRA.

MRAs are generally advocated for mild OSA and simple snoring (i.e. snoring in the absence of OSA) and moderate to severe OSA as an alternative to nasal continuous positive airway pressure or surgery.  MRAs are simple, non-invasive, reversible and cost-effective and may be the basis of definitive life-long treatment.

Patients may recall episodes of dry mouth, increased salivation, facial and/or temporomandibular discomfort, momentary change in occlusion on waking, nausea, choking, unpleasant taste and worsened breathing problems (see *). Side-effects per se of appliance treatment are not conclusive at this stage. Potential direct or indirect detrimental effects to oral health by the MRA should be monitored by regular dental recalls. The life-span of MRAs varies as they may split/fracture and become loose with clenching and grinding forces and deteriorate with cleaning procedures.  The fit may also need to be modified or the MRA replaced if the shape of teeth change with fillings and crowns etc.  It is considered that MRAs will last about 2 years.

* PLEASE NOTE:  Snoring can occur with or without OSA. It is important that a medical diagnosis is made by a Consultant in Sleep Disorder Medicine before treatment.  

Dental Update. January 2003; 30:16-26. - Available to download as a PDF file.