Oral Appliance Therapy in Sleep Medicine

Abstract

Oral appliance therapy provided by the dentist has become a well recognized means by which patients who have a sleep-related breathing disorders (SRBD) may have an alternative to continuous positive airway pressure (CPAP) or surgery for their management. Oral appliances aim at relieving upper airway obstruction and snoring by modifying the position of the mandible, tongue, and other oropharyngeal structures. Oral appliance treatment of SRBD has gained considerable popularity because of its simplicity and supposed reversibility. In 1902, the French physician Pierre Robin laid the foundation for oral appliance therapy. With a monobloc appliance, Robin treated children who suffered from breathing difficulties and glossoptosis caused by hypoplasia of the mandible. The first case of an oral appliance that repositioned the mandible in an adult patient with obstructive sleep apnea (OSA) was not reported until 1980. The first patient series of oral appliance therapy for OSA was reported in 1982 and described the effects of an appliance that repositioned the tongue. Currently, well over 90 different oral appliances are marketed for the treatment of snoring and OSA. Oral appliances have become an optional consideration for patients with mild-to-moderate sleep apnea and for those who simply snore. The role of the dentist actually starts with the ability