Interestingly, most people don’t realise that dentists know anything about sleep apnea and in fact, many don’t. However, in our practice we do. So most people would know they’ve been diagnosed with sleep apnea and that they have at least one choice, and that tends to be CPAP, Continuous Positive Airway Pressure. And so the real problem with the CPAP machine is it has a pretty poor compliance. Only about 50 per cent of people like using it.
After 5 years only that many are likely to be using it compared to a Mandibular Advancement Splint which approximately 80% are likely to be using. What a lot of them don’t know is that there’s another line of treatment called mandibular advancement splints or oral appliance therapy that is provided by dentists, which give very similar long term health outcomes.
The third option, of course, is surgery, either maxillofacial or soft tissue surgery done by an ENT surgeon that tends to be more a salvage operation and is not usually primary treatment. Although, some Maxillo facial surgeries do give a long term improvement.
So when you analyse it, you really have two choices of management for your obstructive sleep apnea. The first one being CPAP, of course, which is really what we call a pneumatic or air splint. Believe it or not, this is considered the Gold standard of treatment and thus tends to be offered as the first line of treatment. And then the other one is a Mandibular Advancement Splint, which makes use of your anatomy and modifies your anatomy overnight while you’re having your apnoeic events to prevent them happening and also helps prevent snoring. So on my left here; I have a model of the head.
So how CPAP that works is that the patient sleeps with a mask over the nose and the mouth or the nose or the mouth or both. A small pump continuously pumps air to Prevent the airway collapsing.
And we push air down into this airway here and that opens up the airway. What a dentist does, is to make two splints and that pulls the jaw forward. That pulls the jaw forward and opens up the airway where the apnoeic events are happening or where the snoring is happening and it also stabilises the tongue and also the soft palate. Stabilises and helps prevent a collapse. So how would that look? Here’s one I prepared earlier. This is a mandibular advancement splint.
There’s many splints. There’s 150 or more to choose from. We use this one not exclusively, but quite a lot. And that’s because they’re very robust appliance and gives great longevity.
So we have been using this appliance for about 15 years and it’s common for us to be reviewing patients who are still using their original appliance.
So as far as cost effectiveness, it’s fantastic. As far as ease of use is fantastic and as a CPAP alternative it’s a very viable option if you’re suitable for it.