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Mandibular Advancement Appliances and Snoring

Simon Ash FDS, MSc. M Orth., Consultant Orthodontist

Introduction:

Mandibular advancement appliances are a relatively new, simple, non invasive complementary treatment for snoring and in selected cases sleep apnoea.

For more than 80 years, Orthododontists have successfully used “functional appliances” to correct jaw imbalance. These work by posturing the lower jaw. Some patients using these appliances reported a cessation in snoring and an improvement in sleep apnoea. Orthodontists have therefore recently developed mandibular advancement appliances, which are based on functional appliances, as a method of managing snoring and sleep apnoea.

What are “Mandibular Advancement Appliances”?

These are custom made dental appliances that are worn in bed at night i.e. you put them in the mouth at night and remove them in the morning. The appliances are usually in two parts, one fitted to the upper and one fitted to the lower teeth. They work as a pair and must be worn together.

How do they work?

The airway between the mouth / nose and the lungs can be considered as a tube. Obstruction / constriction to the tube or the soft tissues vibrating in the airway may be responsible for snoring.

Mandibular Advancement Appliances work by posturing the lower jaw forward (5 – 6 mm). As the jaw is brought forward, the tongue is advanced, the soft palate adopts a more forward position, the surrounding muscles and soft tissues are pulled forward. In this way the airway is improved and kept open. Since the soft tissues are stretched forward, snoring becomes difficult.

These appliances only work when they are worn!

Try making yourself snore with your lips closed and jaw postured forward, it’s almost impossible.

What will I need ?

A well cared for mouth with good teeth. It is advisable to have a thorough check with your dentist before treatment is commenced and to continue regular maintenance once the appliances are fitted. Scrupulous attention to mouth care is essential to ensure that the teeth (i.e. support for the appliances) are maintained.

Changes to the tooth anatomy may alter the fit of the appliances.

We usually advise that patients are assessed by the ENT or other physicians to exclude any other causative factors. This is especially important in sleep apnoea patients.

What will the appliance feel like?

The appliances are fairly bulky. They are hidden within the mouth and rest on the teeth. The lower jaw looks prominent and the neck appears a bit stretched. The appliances and new jaw position require some getting used to and in most cases are well tolerated after a few nights. It is not unusual for patients to discard the appliances in the early hours in the initial stages of treatment.

The lower front teeth may feel sore and become a little mobile to begin with. A dry throat at night or in the morning is not unusual. The tempero-mandibular joints (jaw joints) and the bite may feel uncomfortable in the early stages. This usually settles down as the jaws learn to adapt.

How quickly do they work?

Changes can be expected within a couple of nights. In some patients, the advancement has to be gradually introduced, so the effect may not be so dramatic to begin with.

What is the success rate?

The reported success rate for snoring is about 85 % especially where treatment is accompanied by other measures e.g. weight loss.

The most common reason for failure is patient intolerance. Whilst the appliances have the advantage of being removable, some patients are unable to tolerate them.

Why have a chrome based Mandibular Advancement Appliance?

The “Chrome based Mandibular Advancement Appliances” provide a robust long term solution for snoring. The appliance are constructed of wafer thin precision-made cast chrome alloy to exactly fit each tooth. In this way the weight and pressure of the postured bite is distributed over the teeth. The appliances are snug fitting, have minimal bulk, with limited intrusion into the tongue space. Wedge shaped acrylic blocks are added to the biting surfaces of the appliances and these cause the lower jaw to be postured forward and soften the bite. Elastic bands attached between the appliances are occasionally used to supplement the jaw advancement.

What can I expect to happen?

You will need an Orthodontic consultation and possibly X Rays. The appliances are fitted on the third or fourth treatment visit over a six to eight week time frame.

What are the advantages of this method of treatment?

This non-invasive treatment is provided in an “out patient setting”. The inconspicuous appliances are used strictly at night. They can be used to complement other treatment methods.

What are the disadvantages?

Intolerance of appliances in the mouth. The effectiveness may be reduced with time, so some appliance adjustment may be necessary. The long term effects of jaw posturing in adults is unknown, however this is being actively researched.

What will it cost?

Initial consultation £150 (X rays not included) Treatment £775:- Total cost £ 925