There has been a significant rise in the use of intraoral devices for the treatment of snoring and sleep apnoea. Dentists have an increasing choice of mandibular advancement splints to provide for their patients. Currently, no single device has been proven more effective than another.1 Success is strongly associated with patient compliance. Patients with mild to severe sleep apnoea can have good long-term outcomes with these devices. The reduction in the apnoea/hypopnoea index, as measured during sleep studies, can be up to 60%.1However, our ability to predict success in any individual patient is limited. Currently there is no individual measure or clinical tool that can be used as a predictor of success. This needs to be clearly outlined to potential users.

Further, the effect on the dentition and the temporomandibular joint after long-term use can occasionally be considerable. Patients therefore need to be carefully followed and fully informed of all potential consequences of these devices.1

For patients with sleep apnoea who cannot use continuous positive airway pressure (CPAP) devices, intraoral mandibular advancement splints can be of value. Treatment of sleep apnoea with CPAP devices has been shown to have a profound effect on both the quality of life and life expectancy.2 Presumably, treatment of sleep apnoea with intraoral appliances will have similar beneficial effects, however this has not as yet been shown.

The Australian Dental Association's policy on the use of dental appliances to treat sleep disorders clearly states that dentists should not provide these devices without the patient having a prior specialist (respiratory or ENT) diagnosis. A team approach to the management of these patients with mandibular advancement devices is essential.

 

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ENT head and neck surgeon, Wollongong, New South Wales

Stuart MacKay

ENT head and neck surgeon, Wollongong, New South Wales