WHAT IS THE BEST ORAL APPLIANCE:MAD VS TRD

I AM FREQUENTLY ASKED WHAT IS THE BEST ORAL APPLIANCE. THIS IS A RECENT ARTICLE PUBLISHED IN THE JOURNAL SLEEP.

IT COMPARES TONGUE STABILIZATION WITH MANDIBULAR ADVANCEMENT APPLIANCES.

MANDIBULAR ADVANCEMENT APPPLIANCES HAVE BETTER COMPLIANCE, IE PATIENTS USED THEM MORE. I THINK THAT PATIENTS NEED TO SEE SLEEP APNEA DENTISTS WITH EXPERIENCE WITH MANY TYPES OF APPLIANCE AND WHO UNDERSTAND TMJ DISORDERS AND NEUROMUSCULAR DENTISTRY.

THERE IS NO BEST ORAL APPLIANCE BUT THERE MAY BE A BEST APPLIANCE FOR A SPECIFIC PATIENT AND SPECIFIC SYMPTOMS AN ANATOMY.

Sleep. 2009 May 1;32(5):648-53.
Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial.

Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA.
Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, Australia.
Erratum in:
Sleep. 2009 Aug 1;32(8):table of contents.

Abstract

STUDY OBJECTIVES: To compare the efficacy of a mandibular advancement splint (MAS) and a novel tongue stabilizing device (TSD) in the treatment of obstructive sleep apnea (OSA).
DESIGN: A randomized crossover design was used.
PATIENTS: Twenty-seven patients (20 male, 7 female), recruited from a tertiary hospital sleep clinic.
MEASUREMENTS AND RESULTS: The apnea-hypopnea index (AHI) was reduced with MAS (11.68 +/- 8.94, P = 0.000) and TSD (13.15 +/- 10.77, P = 0.002) compared with baseline (26.96 +/- 17.17). The arousal index decreased for MAS (21.09 +/- 9.27, P = 0.004) and TSD (21.9 +/- 10.56, P = 0.001) compared with baseline (33.23 +/- 16.41). Sixty-eight percent of patients achieved a complete or partial response with MAS, compared with 45% with TSD. The Epworth Sleepiness Scale (ESS) score was decreased with MAS (P = < 0.001) and TSD (P = 0.002). Subjective improvements in snoring and quality of sleep were reported, with a better response for MAS than TSD. Compliance was poorer for TSD, and the side effect profiles of the 2 modalities were different. All patients were satisfied with MAS compared to TSD, and 91% of patients preferred the MAS.
CONCLUSION: Objective testing showed the MAS and TSD had similar efficacy in terms of AHI reduction. Patients reported improvements with both devices; however, better compliance and a clear preference for MAS was apparent when both devices were offered. Longer term studies are needed to clarify the role of TSD

ACNE from CPAP MASK

Question: I use the full face mask with cpap. It seems that where the mask contacts my face, acne breaks out. What causes this and what is best to treat the acne with?

Response: William, Acne from a CPAP mask is not uncommon. While most of my patients eventually switch to oral appliance I can offer a few suggestions.

1. Keep the mask and hoses scrupulously clean

2. A thin layer of Lanolin can be place on the ares where the mask contacts the face 1/2 hour before putting the mask on. The skin should be thoroughly washed and dried first.

Dr Shapira