Better sleep is part of caring for your health

Dental assessment and custom mandibular advancement devices for correctly diagnosed patients when this treatment is indicated.

Snoring results from tissue vibration as air passes during sleep. It may occur alone, but can also signal obstructive sleep apnoea.

In apnoea, the airway repeatedly narrows or becomes blocked during sleep. These interruptions disrupt rest and may be associated with sleepiness, poor concentration and health problems.

A dentist can identify risk signs and contribute to certain treatments, but cannot diagnose apnoea through dental examination alone. Diagnosis requires medical assessment and a sleep study.

Signs that should be assessed

• Loud, habitual snoring.
• Observed pauses in breathing during sleep.
• Waking with a choking sensation.
• Unrefreshing sleep.
• Daytime sleepiness or fatigue.
• Headaches on waking.
• Poor concentration or irritability.
• Hypertension or associated risk factors.

If sleepy while driving or doing hazardous activities, avoid those activities and seek medical assessment promptly.

Diagnosis and medical coordination

Confirming or excluding apnoea requires the sleep test recommended by the specialist. The report establishes whether a disorder is present, its severity and the appropriate treatment options.

We coordinate care with respiratory medicine, sleep medicine, ENT or other professionals as needed. A dental device must not replace prescribed medical treatment on the patient’s own initiative.

Mandibular advancement device

A mandibular advancement device (MAD) is a custom-made two-part splint holding the lower jaw forwards during sleep. This may keep the airway more open and reduce snoring and certain obstructive episodes.

Who may be suitable?

• People with primary snoring after excluding apnoea where appropriate.
• Patients with correctly diagnosed mild or moderate obstructive sleep apnoea.
• Selected patients unable to tolerate CPAP, or for whom a specialist considers this alternative suitable.
• People whose teeth and gums can support the device.

When might it be unsuitable?

• Uncontrolled dental or periodontal disease.
• Too few teeth or insufficient stability to retain it.
• Significant jaw joint problems requiring prior assessment.
• Markedly limited jaw movement.
• Apnoea cases where a specialist recommends another primary treatment.

What does treatment involve?

1. Initial assessment. We review symptoms, previous diagnosis, dental health, gums, bite and jaw joints.
2. Diagnostic coordination. Without a sleep study, we recommend necessary medical assessment before prescribing the device.
3. Records. Scans or impressions and bite records are taken for custom manufacture.
4. Fitting and adjustment. We explain placement, cleaning and use, gradually advancing the jaw according to tolerance and clinical guidance.
5. Reviews. We monitor comfort, retention, bite, joints and symptoms.
6. Effectiveness assessment. Where appropriate, a specialist requests a follow-up sleep study with the device to verify results objectively.

Benefits and limitations

Possible benefits

• Small, quiet and portable.
• Custom-made and progressively adjustable.
• May be easier to tolerate than alternatives for some patients.
• Does not require surgery.

Limitations and possible effects

• Tooth or muscle discomfort during adaptation.
• Increased saliva or dry mouth.
• Jaw joint discomfort.
• Progressive bite or tooth-position changes.
• Insufficient response, requiring follow-up assessment.

Less snoring does not by itself demonstrate controlled apnoea. Follow-up and, when indicated, an objective control test are important.

Other treatments and habits

Apnoea treatment depends on severity, anatomy, symptoms and general health. Options may include CPAP, positional measures, weight management, ENT treatment, surgery or other specialist recommendations.

• Avoid alcohol and sedatives before bed unless medically advised.
• Keep regular sleep habits.
• Avoid sleeping on your back when advised.
• Treat nasal obstruction and other medical problems.
• Do not smoke and maintain a healthy weight when applicable.