Goodlettsville Dental Services

Mandibular Advancement Splint

A mandibular splint or mandibular advancement splint is a device worn in the mouth that is used to treat obstructive sleep apnea and snoring.

The splint treats snoring and mild to moderate sleep apnea by moving the lower jaw forward slightly, which tightens the soft tissue and muscles of the upper airway to prevent obstruction of the airway during sleep. The tightening created by the device also prevents the tissues of the upper airway from vibrating as air passes over them – the most common cause of loud snoring.

Mandibular advancement splints are widely used in the United States and are beginning to be used in Britain and Israel. Where appropriate, they are considered a good therapy choice as they are non-invasive, easily reversible, quiet and generally well accepted by the patient. The focus of improvement in appliance design is in reducing bulk, permitting free jaw movement (i.e. yawning, speaking, drinking) and allowing users to breathe through their mouth (early ‘welded gum shield’-type devices prevented oral breathing).

Less expensive “do it yourself” splints are also available and can provide the same benefits if fitted correctly.

Over the last decade, there has been a significant expansion in the evidence base supporting the use of oral devices in the treatment of OSA. Robust studies demonstrating their efficacy have been underpinned by increasing recognition of the importance of upper airway anatomy in the pathophysiology of OSA. Oral devices have been shown to have a beneficial effect in targeting a number of significant clinical end points. These include the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, blood pressure, aspects of neuropsychological functioning, and quality of life. Elucidation of the mechanism of action of oral devices has provided insight into the factors that predict treatment response and may improve the selection of patients for this treatment modality. A further study by Dr Edmund Rose, University of Freiburg 2004 successfully treated (AHI < 5) 88% of patients with MAS and proposes optimum patient selection to include AHI < 25, BMI < 30 and good dentition.

Another study published in SLEEP 2008 on the Influence of nasal resistance (NAR) on oral device treatment outcome in OSA demonstrates the need for an interdisciplinary approach between ENT Surgeons and Sleep Physicians to treating OSA. The study suggests that higher levels of NAR may negatively affect outcome with MAS and subsequently methods to lower nasal resistance may improve the outcome of oral device treatment.

There are a number of oral devices available to patients suffering from Obstructive sleep apnea and snoring. The efficacy of these devices vary greatly as does the quantity and quality of the research behind them. One of the most widely reseached Mandibular advancement splints the SomnoDent MAS is considered to be the MAS Gold standard among many health care professionals and is manufactured globally by SomnoMed limited with over 30 000 patients worldwide on SomnoDent MAS therapy. The SomnoDent MAS is a clinically validated treatment for mild to moderate OSA and snoring. Its exceptional levels of patient preference, tolerance, compliance and treatment efficacy are backed by clinical research conducted by leading researchers. A study of the effects of oral devices on blood pressure conducted by the Department of Respiratory and Sleep Medicine; Department of Nephrology, St George Hospital and the University of New South Wales Australia found that oral devices were equally as effective as CPAP in lowering the blood pressure of patients suffering from OSA.