Sleep remedies

Sleep medicine is expanding rapidly in the western world. Snoring affects one in three of the population.  

One in ten of these have obstructive sleep apnoea (OSA) primarily due to airway collapse with adverse consequences on many bodily systems. 

Continuous positive air pressure (CPAP) is the treatment of choice for severe OSA, however compliance and availability limit success. 

Most problematic snorers and mild OSA cases remain professionally untreated.

Research has shown that 'over the counter' self medicated mandibular advancement devices (MAD) are to discouraged. 

Dentists working within a multidisciplinary approach are the ideal providers of bespoke MAD’s and should attain clinical competence by attending approved training courses and meet criteria defined by the dental insurers.

When choosing MADs for patients, the dentist needs to be aware that they are treating chronic perhaps worsening lifelong conditions that present many challenges. 

As with any other branch of dentistry, practitioners must provide excellence in patient care, technique and choice of appliance prescribed.

Patient comfort, appliance bulk and aesthetics significantly affect compliance. Devices should be streamlined, enhance rather than encroach into tongue space, giving forward protrusion with minimal vertical jaw opening. There should be preservation of the vertical inter jaw freeway space, coincidentally enabling lip competence.

Appliances should be free of the soft tissues, consequently tooth born and therefore distributing forces over the teeth.

The MAD should allow normal jaw movements except in a backward direction and compliment TMD management rather than introduce or aggravate these conditions. 

MADs should ideally be sterilised before insertion (in line with HTM 0105). The MAD should be cleansable withstanding an autoclave or domestic dishwasher.

The MADs must be adjustable to the individual patient’s changing needs. Patients may have other health issues so a MAD which enables liquid or tablet ingestion while in situ is advantageous.

Given these requirements and the enormous increasing unmet treatment need, MADs must be resilient, robust and long lasting. They should require minimal if any renewal, repair or maintenance and should be inexpensive over the life of the MAD.

Dental training and experience with partial dentures reminds us that acrylics and thermoplastics should be considered temporary material in the mouth as they fail to meet many of the above ideals. Metals and chrome cobalt in particular (as used in the Somnowell MAD) are currently the material of choice.

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