Snoring and obstructive sleep apnea (OSA) are highly prevalent sleep-related breathing disorders that significantly affect quality of life and long-term health outcomes. While Continuous Positive Airway Pressure (CPAP) therapy remains the gold standard for moderate to severe OSA, oral appliance therapy has emerged as an effective, evidence-based alternative – specifically for patients with primary snoring or mild to moderate OSA.
Snoring is caused by vibration of soft tissues in the upper airway due to airflow turbulence during sleep. Although often benign, habitual snoring may indicate underlying airway obstruction. Obstructive sleep apnea (OSA) is characterized by repetitive episodes of partial or complete airway collapse during sleep. Common symptoms of OSA are oxygen desaturation, interrupted sleep, excessive daytime sleepiness and increased cardiovascular risk. Untreated OSA is associated with hypertension, arrhythmias, stoke, insulin resistance and increased accident risk.
OSA has been strongly connected to tooth attrition (tooth wear), primarily through its association with sleep bruxism. Bruxism is characterized by clenching or grinding one’s teeth. Bruxism can lead to flattening or chipping tooth surfaces, enamel loss with dentin exposure, increased tooth sensitivity and additional forces being put on the teeth causing cracked teeth in severe cases.
There are two common clinical suggestions of how OSA is linked to bruxism. One being that OSA triggers sleep bruxism. During OSA episodes, the airway collapses, oxygen levels drop and the brain briefly arouses the person to reopen the airway. These arousals often active jaw muscles that can activate sleep bruxism. The other being some researchers suggest that bruxism may be a subconscious attempt to activate muscles to reopen the airway. This would suggest that sleep bruxism is a compensatory response to airway obstruction.
The most common recommended oral appliance for OSA is the mandibular advancement device (MAD). These oral appliances are custom-fabricated intraoral devices worn during sleep to maintain airway patency. They are typically prescribed by sleep physicians and fabricated and fitted by trained dentists with experience in dental sleep medicine. The devices are adjustable and titratable to optimize their therapeutic effect.
According to the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM), oral appliance therapy is indicated for patients with primary snoring, mild to moderate OSA, patients intolerant to CPAP or those who prefer an alternative to CPAP. The devices are also popular with the patient population requiring a portable treatment option in comparison to the CPAP. Diagnosis of OSA should ideally be confirmed with a sleep apnea test before initiating therapy.
Oral appliance therapy represents a clinically validated, patient-centered treatment option for snoring and obstructive sleep apnea. When properly prescribed, custom-fitted and monitored by trained professionals, oral appliances can significantly reduce airway obstruction, improve sleep quality and enhance long-term health outcomes. For many patients, oral appliance therapy is not merely an alternative to CPAP, but is the treatment option that they can and will consistently use, making it a powerful tool in the management of sleep-disordered breathing.
