Name of the Procedure:

Oral Device/Appliance Used to Reduce Upper Airway Collapsibility
Technical Term: Mandibular Advancement Device (MAD) or Oral Appliance Therapy (OAT)

Summary

This procedure involves the fitting of a specially designed oral device to help keep the airway open during sleep. It is used to treat conditions like obstructive sleep apnea (OSA) by preventing the airway from collapsing.

Purpose

The primary goal of this procedure is to reduce the episodes of upper airway collapsibility during sleep, which leads to interrupted breathing, commonly seen in obstructive sleep apnea. By maintaining an open airway, the device aims to improve oxygenation, enhance sleep quality, and reduce associated health risks.

Indications

• Obstructive Sleep Apnea (OSA)
• Snoring
• Mild to moderate cases of sleep-disordered breathing
• Patients who cannot tolerate Continuous Positive Airway Pressure (CPAP) therapy

Preparation

• A thorough dental and medical history
• Sleep study to diagnose OSA
• Dental impressions and possibly imaging to design the device

• Instructions to maintain good oral hygiene

  Procedure Description

  1. Initial Consultation: Assessment by a dental or sleep specialist to determine suitability.
  2. Impressions and Fitting: Dental impressions are taken to create a custom fit for the device.
  3. Device Fabrication: The oral appliance is prefabricated and adjusted as needed.
  4. Fitting and Adjustment: The device is fitted to the patient’s mouth and adjusted for comfort and effectiveness.
  5. Instruction: Patients are educated on how to use and care for the device.

  Tools/Equipment: Dental impression materials, mandibular advancement device, adjustment tools

Anesthesia/Sedation: None typically required

Duration

The initial fitting and adjustment session usually takes about 1-2 hours.

Setting

Outpatient clinic or dental office

Personnel

• Dentist or sleep specialist
• Dental technician

Risks and Complications

• Minor discomfort or soreness
• Excessive salivation or dry mouth
• Temporomandibular joint (TMJ) discomfort
• Tooth movement or bite changes

Benefits

• Improved sleep quality
• Reduced symptoms of OSA and snoring
• Non-invasive and relatively comfortable
• High compliance rate for users
• Benefits can often be noticed immediately, with ongoing improvement over time.

Recovery

• Follow-up appointments for adjustments and monitoring
• Instructions on nightly use and care of the device
• Minimal downtime; normal activities can typically be resumed immediately

Alternatives

• Continuous Positive Airway Pressure (CPAP) therapy
• Surgery (e.g., Uvulopalatopharyngoplasty - UPPP)
• Weight loss and lifestyle changes

• Positional therapy

  Pros and Cons of Alternatives:

• CPAP: Highly effective but often poorly tolerated due to discomfort.
• Surgery: Can have permanent results but involves higher risks and longer recovery.

• Weight Loss/Lifestyle Changes: Beneficial but may not be sufficient as a standalone treatment.

  Patient Experience

  Patients may experience some initial discomfort or adjustment period while getting used to the device. However, most find it tolerable. Pain is usually minimal and can be managed with over-the-counter pain relievers if needed. Regular follow-ups ensure the device continues to fit well and work effectively.