Mandibular advancement devices

Refers to a device worn in the mouth that is used to treat orofacial disorders including: obstructive sleep apnea (OSA), snoring, and TMJ disorders.

Known as mandibular advancement devices, sleep apnea oral appliances, oral airway dilators and sleep apnea mouth guards.

The splint treats snoring and sleep apnea by moving the lower jaw forward slightl.

The use of the device tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep.

The tightening prevents the tissues of the upper airway from vibrating as air passes over them, causing loud snoring.

Non-invasive, easily reversible, quiet, and generally well accepte.

Goals of management design is to reducing bulk, permitting free jaw movement and allowing the user to breathe through the mouth.

Work by protruding the mandible and tongue to keep airways open during sleep.

Oral devices are beneficial in several ways, including: polysomnographic indexes of OSA, measures of sleepiness, blood pressure, aspects of neuropsychological functioning, and quality of life.

Successfully treats OSA in 88% of patients.

Optimum patient selection to include AHI < 25, body mass index (BMI) < 30, and good dentition.

A 2008 study published in Sleep on the influence of nasal resistance (NAR) on oral device treatment outcome in OSA demonstrates the need for an interdisciplinary approach between ENT surgeons and sleep physicians to treating OSA. The study suggests that

Higher levels of nasal resistance may negatively affect outcome with mandibular advancement devices and methods to lower nasal resistance may improve the outcome of oral device treatment.

Oral devices are equally effective as continuous positive airway pressure (CPAP) devices in lowering the blood pressure of patients suffering from OSA.

Randomized control studies suggests splints may be as effective in patients with a range of severities of obstructive sleep apnea.

Both CPAP and mandibular advancement devices are associated with reduction in blood pressure in sleep apnea care.

Both methods appear effective in alleviating symptoms, improving daytime sleepiness, quality of life and some aspects of neurobehavioral function.

More test subjects and their partners feel that CPAP is the most effective treatment, although mandibular device was easier to use.

Some patients find these devices uncomfortable, although many patients find them less bothersome than CPAP masks..

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