With over 90 FDA approved different sleep appliances on the market, it's puzzling to know which one is right for your patient. Not all 90 are viable and none of them are perfect, but there are still a large number of appliances that effectively treat sleep disorders that you will want to know how to use. In the end, what your real goal is to make sure that you take care of your patient's individual needs with the appliance that you choose to use.
Sticking with those devices that are backed by good published papers and high quality labs allows several to pick from. To be able to meet the needs of patients, the sleep dentist must master three or four and be adept at a few others. That means you must try out an unfamiliar device on some patients just so you'll learn it. Having the confidence that comes from using a high quality appliance will make that trial a bit easier.
In reality, all of them do essentially the same thing – bring the mandible forward to open up the airway behind the tongue. I describe it this way: During sleep, especially the most relaxed sleep on your back, tissues like the base of your tongue bunch up in back and close off your airway. Our device will stabilize your jaw so it can't fall back and also actively pulls your tongue forward a bit, opening the space to breathe.
When we think about mandibular advancement devices, an important feature is that the patient can begin in a place that is comfortable and move forward as they need to eliminate apnea. They can be titrated by you or the patient until the mandible is forward enough to keep their airway open. Some examples are:
Midline Anterior Adjustment: This type uses a mechanism in the middle and front of the mouth to move the jaw forward. Very simple, relaxing and fits many mouth shapes. This is not the best for deep bites or narrow, V-shaped arches. Generally a small design is good for small lip openings.
Midline Palatal Adjustment: Adjusting the screw advances the lower jaw position. This is best for wide flat palates, but also crowds the tongue somewhat. Very good for patients with large arches and little room buccal to the maxillary teeth.
Bilateral Buccal Adjustment: Many sleep appliances on the market are this type. It consists of two adjustable mechanisms buccal to the teeth to get the mandible forward. Less impingement on the tongue space is a feature, but watch out for patients with large tori or tight buccal space. Not as good for patients with small lip openings.
Each of these designs is excellent for some patients and would be a poor choice for others. Only clinical experience can teach you which ones match best, so it's important to study the various choices, try them on patients and gain wisdom from your experience. Taking action helps you learn, and you'll provide better and better service as you grow.
Steve Carstensen, DDS [ www.stevecarstensendds.com ]