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

Study supports MAD effectiveness and health of TM Joints

A new study in Sleep and Breathing concluded that" long-term usage of an OA does not cause impairment to the temporomandibular joint." The study also concluded that "There was a long-term improvement in the ESS (epworth slepiness scores) values over the years analyzed."

PubMed abstract is included for reference
Sleep Breath. 2009 Nov;13(4):375-81. Epub 2009 May 1.

Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.
Giannasi LC, Almeida FR, Magini M, Costa MS, de Oliveira CS, de Oliveira JC, Kalil Bussadori S, de Oliveira LV.
Institute of Research and Development IP&D, University of Vale do Paraíba, São Paulo, Brazil. odontogiannasi@uol.com.br
OBJECTIVE: The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms. MATERIALS AND METHODS: Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months. RESULTS AND DISCUSSION: The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients. CONCLUSIONS: We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.