Tailoring the Oral Appliance To the OSA Patient

By Arthur M. Strauss, DDS

Dentists who have working experience with many oral appliances have observed that some not only work differently than others but differently on different patients, who, of course, vary in both their anatomy and temperament.

The book Oral Devices for the Management of Snoring and Obstructive Sleep Apnea (OSA) and Snoring and Obstructive Sleep Apnea, address early concerns of dentists involved in the formation of the Sleep Disorders Dental Society, later to become the American Academy of Dental Sleep Medicine.

Published studies suggest two types of oral appliances effectively treat snoring and OSA tongue retaining devices (TRD) and anterior mandibular retaining devices (MRD). The TRD is made of a soft flexible vinyl type bulb holding the tongue (by its front portion) forward between the front teeth as one may stick their tongue out at somebody, forward but unstrained. This impacts more of the upper back of the throat.

The MRD is usually made of a more rigid material fitting on the teeth of one, but usually both jaws either pulling or pushing the lower jaw forward and the tongue from below and behind its tip forward. This impacts more of the lower back of the throat.

Both TRD and MRD vary in their design, including the material from which they are made, how they are held in place, and what type of force is required.

MRD's additionally vary in

Positioning and how easily the jaws can move,
How easily can jaw position be modified,
Who (patient or dentist) accounts for changing the jaw position,
How it is anchored and how well it remains anchored well, and if it loosens can it be re-tightened,
How fragile it is and how easily can it be repaired,
How easily is it kept clean and does the material degrade over time,
Does the design impede or favor the position of the tongue within the mouth, providing enough room for allowing modification to improve this.
Matching the design characteristics of a particular appliance to the anatomy, functional movement and temperament of each patient is best determined through careful examination and analysis of them including a trial run of testing appliances through what are called “trial procedures”.

The article in Your Health Magazine, “Trial Procedures In Oral Appliance Therapy,” addresses how trial procedures are use to deliver the best result for the patient.