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Sleep Apnea; Fixed jaw anti-snoring appliances
Dental MADs (Mandibular advancement devices) fall into two general categories. Fixed and Adjustable. Fixed appliances cannot be adjusted, always maintaining the same jaw relationship for the life of the appliance. They were popular early in the history of the dental treatment of OSA, but as our knowledge of the disorder has advanced, they have fallen out of favor. Adjustable snoring appliances have a very serious advantage over fixed jaw appliances. As the patient’s jaw musculature and ligaments adapt over time with the jaw advancement brought about by the appliance, an adjustable appliance may be advanced further to bring about more relief. This is not possible with a fixed jaw appliance.
A fixed-jaw-relation type anti-snoring device is the least expensive appliance available for the treatment of snoring and obstructive sleep apnea. A number of manufacturers make very inexpensive prefabricated appliances in which the patient is instructed to bite into a double sided prefabricated plastic tray lined with flexible thermal plastic. The patient bites with the lower jaw thrust out (protruded) and when the thermal plastic cools, impressions of both the top and bottom teeth remain behind and the tray, along with the thermal lining becomes an “immediate” anti-snoring device. I have found that this type of “quick and dirty” device works reasonably, but is generally is not very durable and not always very comfortable. They have proved most useful as provisional (non permanent) appliances for emergency or experimental purposes to see if a patient can tolerate a jaw protruding device. You don’t have to go to a dentist to try one. Several such devices can be found by clicking here for a Google search of the current crop of prefabs. .
More durable and permanent appliances are custom made in a dental laboratory. One of the least expensive and most popular types is called an elastomeric anti-snoring device. Impressions of both upper and lower teeth are taken by your dentist, and plaster models made from those impressions are sent to the lab along with a protrusive bite registration. (The patient is instructed to bite into a horseshoe of soft wax with his lower jaw protruded as far as he can comfortably extend it. Dentists click here to order a George gauge to help in this task, and here to learn how to use one.) The lab sends back a finished appliance made out of a silicone rubber which looks like the one in the images below. These are surprisingly comfortable, and the patient can breath freely through the holes seen in the front view below.
Actually, once the patient gets used to having the appliance in place, the “panicky” feeling that he or she has to be able to breathe through the mouth vanishes and the patient spends the night breathing through the nose, so the holes are mostly a temporary “psychological” necessity. One of the unsung advantages of this type of anti-snoring device is its indestructibility. It cannot break under pressure and the fit, with a few adjustments, is generally perfect. They never break, even under the extreme pressures placed upon them by the worst bruxers. Since they are also the least expensive laboratory constructed bruxing guard, patients may be able to afford a new one every so often in order to advance the lower jaw. Probably the most important advantage to the elastomeric bruxing guards is that it is the type of anti-snoring device least likely to cause serious shifting of the teeth over time.
The NAPA appliance has been in use since 1983 and ranks as the oldest snore appliance in continuous use. Like the Elastomeric appliance above, it is built in a fixed jaw relationship which cannot be changed. It is made out of hard acrylic and is held in place by eight clasps which firmly grasp the teeth. The extension in front is a breathing tube which keeps the lips apart. Over the years, it was found that this arrangement was unnecessary since patients tend to breathe through their noses when asleep and block the breathing tube with their tongue. However, many patients like the security of an airway which is always open and unobstructed.
Tongue retaining sleep apnea devices are made almost exclusively for persons who are totally edentulous (in other words, they have no teeth, especially in the lower arch.) They are actually bulbs which are squeezed and applied to the tongue. The suction draws the tongue into the bulb, and the device then is placed “crossways” against the outside of the mouth to to draw the tongue foreward and away from the back of the throat.
These appliances do not advance the lower jaw, and are not nearly as effective as a standard tooth borne sleep apnea appliance (MAD), but they do produce some degree of relief of the airway.