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MANDIBULAR ADVANCEMENT SPLINTS IN SLEEP-RELATED BREATHING DISORDERS

For the past 20 years, mandibular advancement splints have been used for the treatment of sleep apnoea and associated sleep-related breathing disorders.  These devices are indicated for the following conditions:

1.  Primary snoring.

2.  Upper airways resistance syndrome.

3.  Mild to moderate sleep apnoea with an apnoea/hypopnoea index (AHI up to 25/hr).

It is suitable in patients with a body mass index (BMI) of up to 30.00 kg/m². As a general rule, the patient should have ten upper and ten lower teeth for the splint to be effective and have a dental assessment before the splint is used. Some patients with an apnoea/hypopnoea index of  >25/hr, a mandibular advancement splint may be effective occasionally. It is also indicated in patients who are intolerant of CPAP.

It has been shown in the literature that splints should be made especially for that individual and "over the counter splints" are not generally effective. Solid block splints are less comfortable and as a general rule, produce poorer outcomes than splints which allow movement of the upper and lower jaws. The most comfortable and most effective splint is the SomnoMed splint, as this allows more natural movement of the upper and lower jaws as well as closure of the teeth. 

It is essential that a dentist is involved in the appraisal of the patient and the fitting of the appliance. The management of a mandibular advancement splint is a team effort involving both the sleep physician and the dentist with a special interest in this. 

To assess the effectiveness of the splint it is preferable for a sleep study to be done with a mandibular advancement splint in the mouth.

The article below is a position paper on the use of mandibular advancement splints, written by Dr Susanne Schwarting, Dentist from Kiel Germany , whose talk on this topic I attending on 7 November 2007 , in Brisbane . 

The link to the SomnoMed web site is www.somnomed.com.au .  The SomnoMed splint like CPAP is an Australian invention.

A madibular splint is a small plastic device worn in the mouth; it may be used to improve the quality of sleep by reducing some types of sleep apnoea and snoring. The splint is used in patients with very mild sleep apnoea and also in patients with moderate to severe sleep apnoea who do not tolerate or refuse CPAP (however in moderate to severe sleep apnoea the splint will not be as effective).

The splint works by reposition and maintaining the lower jaw forward while the person sleeps. This opens the upper airway by tightening the tissues at the back of the throat allowing air to flow freely.

Common problems associated with the mandibular splint include:

  • Discomfort and soreness
  • Saliva build-up at night
  • May cause damage to teeth, oral tissue and jaw joints
  • Toothache and jaw joint pain
  • Permanent change in the position of the jaw or teeth
  • In very limited number of cases, the splint may make the sleep apnoea worse.

To avoid any problems it is recommended that you visit the dentist regularly

Your specialist will be able to inform you whether this is the most suitable treatment otherwise he/she may suggest CPAP.

 

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