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

Dentures and oral appliances for treating sleep apnea

Do you have a CPAP device/snore preventer that can be used by a patient who is totally edentulous?

Yes there are appliances that treat apnea. The first class is TRD or tongue retaining devices. They are not my favorite but are an easy option for denture patients.

I prefer to stabilize dentures with implants which allows the use of any oral apppliance.

I make a custom appliance that is spring loaded to push the upper and lower denture in place while advancing the mandible. It is a custom appliance and has not been approved by the FDA so it cannot be marketed.

An interesting fact is some patients with sleep apnea sleep with their dentures out. In some patients, I just had one recently, just wearing your dentures while sleeping can cure apnea.