Sleep Apnea: Collaborative Approach To Oral Appliance Therapy

By Arthur M. Strauss, DDS

One appliance does not fit all. To date, there has been little to no research to match numerous varying patient characteristics to the most suitable type (TRD or MRD) of oral appliance for them. This is why it is important for the doctor and patients to collaborate, in navigating through these variables to yield the best results.

Because everyone is unique in the structure and mobility of their teeth, jaws and throat, the choice of the inappropriate appliance can result in an ineffective resolution of sleep apnea symptoms. It can also result in ineffective function, fit and detrimental side effects. All of this can be avoided with the appropriate match and customization of the appliance to the patient.

Clinical testing is required to narrow down the selection of first “the type” and second “the design” of the appliance. This process is referred to as trial procedures. A trial period to test the two (TRD and MRD) types of appliances along with variations of them is critical in working with each patient until the most suitable treatment appliance is found, then, customized in its design and manner of use.

The collaboration between doctor and patient is a key factor in capitalizing on mutual involvement in both observation and feedback, often leading to innovative solutions to different challenges. It is in contrast to a more passive “Caretaker” approach of unilaterally selecting and fitting an appliance to the “passive” patient.

In trial procedures to ensure appliance selection and customization success, we are concerned with:

Ease of use and its impact on compliance in use of the appliance

Undesirable side effects and manageability through appliance choice and/or other intervention

Stresses upon the appliance during sleep and appliance design addressing cause and/or effect

Effectiveness of the trial appliance and how that relates to the desirable treatment appliance

This type of trial procedure has been in use for over 20 years, to assure our mutual diligence in achieving the best results possible. It is apparent that skipping trial procedures is like playing roulette where the probability for maximal success could be greatly diminished.

If you’re reading this article and this publication you “care enough to know” because “you know enough to care” and you prefer to collaborate in your care.