Issues to Consider
Along with identifying patients for whom oral appliances may work best, other issues that may need consideration include the major side effect of these appliances, tooth movement or occlusal changes.
Explore This IssueDecember 2011
Dr. Lowe considers this a small disadvantage compared to the benefit of controlled OSA. “The longer we are in the field, the more we are accepting that [tooth movement] as a side effect and we work around it because compared to decreased oxygen to the heart, it is a pretty minor thing,” he said.
Finally, an important role for oral appliances may be in their use in conjunction with CPAP. “CPAP and oral appliances can be used interchangeably,” said Fernanda Ribeiro de Almeida, DDS, PhD, assistant professor of dentistry at the University of British Columbia in Vancouver, BC, Canada. She said many patients who use CPAP routinely may be more compliant overall with treatment if they use oral appliances when CPAP is less convenient, such as on the weekends or when travelling.
Disclosures: Dr. Cistulli has contributed to the development of the mandibular advancement splint. He has also consulted for and has been on the advisory board for oral device maker SomnoMed and has financial interest in the company. Dr. Remmers receives royalties from AutoCPAP and is part owner of Zephyr, the company that manufactures MATRx a test for selecting patients for oral appliance therapy. Drs. Fernanda and Tucker report no relevant financial ties.