Snoring is a common problem with some studies identifying up to 50% of the population as snorers. It is caused by a vibration of the tissues in the upper airways and apart from being annoying for a partner it has been postulated that snoring may be associated with cardiovascular disease, metabolic syndrome, morning headaches, interrupted and daytime sleepiness. Furthermore, it is clear that simple snoring exists on a continuum with obstructive sleep apnoea which, when left untreated, can have serious health effects. The treatment of simple snoring includes weight loss, sleeping on your side, snoring mouth guards, avoiding alcohol and a mandibular advancement splint. In this blog, we will discuss the mandibular advancement splint as a method to treat snoring.
What is a Mandibular Advancement Splint (MAS)?
MAS’s attach to both the upper and lower teeth to advance and maintain in the lower jaw in a forward position. By doing this they aim to stretch the soft tissues and increase the upper airway patency and calibre. By this method they can reduce and sometimes eliminate snoring.
Who is a candidate for a MAS?
Most people who suffer from simple snoring or mild to moderate obstructive sleep apnoea are suitable for a MAS. Prior to having one fitted it is required to have a sleep study, this is to establish a diagnosis, a baseline, and to assess the efficacy of the splint. Should you require any general dental work, such as fillings or gum treatment, this will need to be completed prior to construction of the MAS. It is also suggested that people that suffer from a diagnosed or ongoing jaw joint problems should avoid a MAS.
Are there any side effects?
Like any medical intervention MAS can have some side effects. Fortunately, the side effects tend to be minimal. Some short-term side effects include: excessive salivation, dry mouth, teeth discomfort, masticatory (chewing) muscle tenderness and TMJ (jaw joint) discomfort. These side effects tend to disappear after an adjustment period of a few days to a few weeks. While mostly minimal, longer term and persistent side effects may include dental and skeletal changes and temporomandibular disorders. Regular monitoring for these longer-term side effects by your dentist is essential.
How Successful are MAS in treating snoring?
There exists a lot of high quality evidence that MAS’s are effective in the treatment of snoring. The evidence reports a reduction in the number of snores per hour, snoring occurring on fewer nights per week and a reduction in the loudness of the snoring.
Which MAS works best?
There are many types of MAS’s from the cheaper boil and bite to the more expensive custom fit and adjustable splints that allow you to select the degree of lower jaw advancement. The key to the success of mandibular advancement splints it that they remain in place and are comfortable during sleep. It is generally accepted that custom fit devices are and more retentive and better tolerated by patients. Furthermore, an adjustable appliance has been shown to be more effecting in treating snoring and obstructive sleep apnoea and so is preferred over non-adjustable appliances.
Dr Michael Russo
BCom, BDent, Grad. Dip. Clin. Dent. (Oral Implants)
References:
Deary, V., et al. (2014). “Simple snoring: not quite so simple after all?”
Nerfeldt, P. and D. Friberg (2016). “Effectiveness of Oral Appliances in Obstructive Sleep Apnea with Respiratory Arousals.” J Clin Sleep Med 12(8): 1159-1165.
Ramar, K., et al. (2015). “Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015.” J Clin Sleep Med 11(7): 773-827.
Ngiam, J., et al. (2013). “Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea.” Aust Dent J 58(4): 408-419.
Okuno, K., et al. (2016). “Prediction of oral appliance treatment outcomes in obstructive sleep apnea: A systematic review.” Sleep Med Rev 30: 25-33.
