What is a Dental Sleep Appliance or Mandibular Advancement Device (MAD)?
MAD’s are often described as being similar to an athletic mouth guard or an orthodontic retainer. They are custom made and specifically designed to fit only you, and worn over both the upper and lower teeth when you sleep. Although oral appliances do not work on everybody, a well-made, well-fitted appliance may reduce or eliminate snoring, and may significantly relieve symptoms of OSA.
How does the Dental Sleep Appliance work?
Sleep Appliances work by holding the lower jaw slightly forward during sleep and thereby opening the airway at the back of the throat, which is responsible for the snoring and obstruction. The tongue is attached to the lower jaw, and with the jaw held forward the tongue is prevented from collapsing back.
What is the best treatment for snoring?
There is NO single ‘best treatment for every person’. Dental sleep appliances are generally the most effective treatment for snoring and mild to moderate OSA – with the least side effects, whilst CPAP is the treatment of choice for severe OSA. Surgery is necessary for many people, but is usually only around 55% effective with significant potential side effects, including severe post-operative pain and occasional regurgitation of food through the nose. Other treatments including sprays, medications, and pillows are often recommended but most lack scientific evidence of any benefit. However, in some patients these may be useful adjuncts to using a sleep appliance, while weight loss, surgery, CPAP and a sleep appliance may be used in combination. Avoiding caffeine, nicotine and alcohol prior to sleep is also very helpful.
Are Dental Sleep Appliances effective?
The American Academy of Sleep Medicine and the Australian Sleep Association now consider dental sleep appliances a first line treatment for snoring and mild to moderate OSA. Dental sleep appliances have been scientifically proven to be very effective – ‘over 95% of people are satisfied with the level of improvement with their snoring when assessed and treated correctly’. The appliance will improve the quality of your sleep but it may take several nights of more refreshing sleep for the tiredness to go. In some cases, the improvement in health and tiredness may occur more gradually over weeks or months.
What if I am missing teeth or have a bridge or denture?
There are new appliances that can be successfully used in many different situations – even if all the upper teeth are missing. You will need to have at least a total of 6-8 lower teeth however to be able to utilize a conventional dental sleep appliance. The tongue-retaining device is an appliance specifically designed for people who are missing all their teeth. It is important to have a thorough assessment of the teeth, gums and jaws to ensure predictable, successful results with minimal problems long term. Implant supported dentures and a MAD is an option for people with no upper or lower dentures.
Are all Dental Sleep Appliances as good as each other?
No. There are currently over 50 different dental sleep appliances throughout the world (probably more). Many of these appliances have not had studies to prove effectiveness, are not adjustable, and many are “one size fits all” or designed by the latest self proclaimed guru. While these appliances can be considerably less expensive, the fit is often a problem and most people find them difficult to wear. Professionally made sleep appliances are Government approved having scientific studies demonstrating effectiveness and comfort. It is important to note that there is no one appliance that is ideal for each and every situation. The choice of the ideal appliance for each person depends on factors such as the size, position and number of teeth as well as the size and position of the jaws.
Are Dental Sleep Appliances comfortable to wear?
Although the mouth is a very sensitive area, the vast majority of people adapt within a night or two and find the appliance surprisingly comfortable. This is because the appliances we make are tailor-made and very thin. Once the snoring stops and they are feeling more refreshed, and have adapted to the appliance, most people would much rather have it in during sleep than out.
How much does a Dental Sleep Appliance cost?
The initial consultation includes a thorough assessment of your snoring or possible sleep apnoea and entire medical and dental history. Dr Eldridge will also assess the health of your jaw joints and the mouth and the suitability for a dental sleep appliance. This visit is an opportunity to see several of the appliances available and to discuss all aspects of dental sleep appliances and your condition. The treatments available range from $600 to $1495 and depend on the type of appliance. State of the art appliances are in the upper range but the choice of appliance depends on several individual factors including the shape, health and configuration of your teeth and jaws. This is all assessed at the initial consultation.
Can I claim a rebate from my private health insurance?
Yes. The majority of private health insurance covers treatment using Dental Sleep Appliances. Often a refund of a third to a half is paid back to you, but you need to check with your own health fund as individual cover varies. A full list of the items numbers used for treatment and insurance rebate is available at your initial consultation. Dr Eldridge always recommends people take this information home with them to consider their options before proceeding with any treatment. Please see our News section for further information regarding health insurance rebates Health Insurance Matters.
What is included in the treatment fee?
A treatment plan is provided that includes the initial consultation, all necessary impressions, bite registrations, radiographs, the sleep appliance, review and adjustment appointments, and a 6 week review appointment. Letters will also be written to your GP, to any specialists you may have seen or been referred by, and to your regular general dentist to keep each practitioner informed and up to date with your treatment plan and progress.
Can you guarantee the treatment will work?
Yes. Treatment with sleep appliances will not commence if it is not considered to be a correct choice of treatment for you. Often a custom made temporary appliance can be inexpensively constructed to test the effectiveness and compliance of a sleep appliance prior to your commitment to the longer-term appliance. In the unlikely event that you are not completely satisfied with the treatment, simply return the appliance within 30 days and you will receive a refund for all laboratory fees. Refunds do not apply to patients for whom oral appliance treatment is not recommended but wish to trial it anyway.
How long does a Dental Sleep Appliance last?
If you do not clench or grind your teeth, a dental sleep appliance can last for around 3 or 4 and often many more years. Dr Eldridge now has people returning for review that have had the appliance for almost 10 years and it is still functioning perfectly. Even if you do clench and grind your teeth the appliance can still last for years and has the added benefit of protecting your teeth and dental work. However, just like your car, a sleep appliance will require regular ‘servicing and tune ups’ including the unexpected ‘repair job’ which will incur minimal costs. If the appliance needs to be replaced after several years this is usually done at a reduction of 30-50% off the original cost depending on the type of appliance. Typically this fee represents the laboratory fees only to ensure you continue to receive best practice treatment for your OSA.
I don’t want to use the CPAP machine – is the dental sleep appliance an alternative?
Please keep in mind, CPAP is considered the gold standard of treating severe OSA and cessation of its use will only be considered in consultation with your GP and Sleep Physician. Based on many scientific studies, Dental Sleep Appliances are now regarded as an alternative for patients that cannot or do not wish to use CPAP as they provide in many cases as good if not better long term compliance. The reported experience of CPAP users who have made the change is invariably that Dental Sleep Appliances are much more comfortable than CPAP. Many people with severe OSA might continue to use their CPAP and use a Dental Sleep Appliance when travelling or at times where there is no access to power. They may also use CPAP for half the night and a MAD the other half of the night. The possibility of changing to a Dental Sleep Appliance can be determined at the initial consultation but must always be considered very carefully.
Do I have to wear the Dental Sleep Appliance forever?
No. There may be other methods that you can introduce for yourself that can help overcome the problem. This is very individual and assessed and discussed in the first consultation. For many people weight loss, exercise or changing body position during sleep can go a long way to overcoming snoring and sleep apnoea. This can be difficult to achieve if you are sleepy and tired. The use of a dental appliance can result in a boost in energy levels through better quality sleep and hence the impetus to make lifestyle changes. Regular reviews and follow-up sleep studies are very important to monitor these changes as they occur. Surgery with an ENT is another option for many people to help reduce any anatomical causes of snoring and OSA. Again, this option is determined at the initial consultation.
Are there any side effects?
The vast majority of people have no side effects. A small percentage of people have minor side effects such as excessive saliva, jaw tenderness, pressure on teeth and bite changes. Most side effects are temporary and disappear after a day or two or with a simple adjustment.