A mandibular splint or advancement of mandible splint ( MAS ) is a tool used in the mouth used to treat orofacial disorders including: obstructive sleep apnea (OSA ), snoring, and TMJ disorders. This device is also known as a mandibular progress device , oral sleep apnea apparatus , mouth inhalation and sleep apnea sleeper >. We recommend that sleep doctors consider prescribing oral equipment, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternative therapies. The American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) recommend that sleep doctors should prescribe oral apnea sleep equipment for adult patients requiring treatment for their primary snoring without obstructive sleep apnea) rather than no treatment and for patients with obstructive sleep apnea but are intolerant of CPAP therapy, or for those who prefer alternative therapies.
Video Mandibular advancement splint
Usage
Splint treating snoring and sleep apnea by moving the lower jaw slightly forward, which tightens the soft tissues and upper airway muscles to prevent airway obstruction during sleep. Firming made by the device also prevents the upper airway network from vibrating as the air passes through it - the most common cause of snoring.
Mandibular advance splints are widely used in the United States and are beginning to be used in the UK. According to current American Academy of Sleep Medicine treatment guidelines, oral equipment should be considered for patients with mild to moderate snoring or sleep apnea, or as an alternative to CPAP in patients who are not adherent to severe obstructive sleep apnea. If necessary, they are considered good therapeutic options as they are noninvasive, easily reversible, quiet, and generally well received by the patient. The focus of improvements in device design is to reduce the mass, allow for free jaw movement (allowing yawning, talking, and drinking), and allowing the user to breathe through the mouth ("wet shield" welded early - type device prevents oral breathing).
Evidence accumulated to support the use of oral devices in the treatment of OSA, and studies showing its efficacy has been supported by the increased recognition of the importance of upper airway anatomy in the pathophysiology of OSA. The oral device has been shown to have beneficial effects associated with some areas. These include the polysomnographic index of OSA, subjective and objective measures of drowsiness, blood pressure, aspects of neuropsychological function, and quality of life. The description of the oral device action mechanism has provided insight into the factors that predict the treatment. response and may improve patient selection for this treatment modality.
A 2008 study published in Sleep on the influence of nasal resistance (NAR) on oral device treatment results at OSA shows the need for an interdisciplinary approach between ENT surgeons and sleep doctors to treat OSA. This study shows that higher NAR levels can negatively affect the results with MAS and then methods to decrease nasal resistance may improve outcomes from oral device treatments.
They are generally more successful in treating mild and moderate apnea and are less effective in treating severe sleep apnea, although good success is action even in severe sleep apnea. They can bring the patient's apnea experience level down significantly but fail to completely eliminate it.
A meta-analysis of 51 randomized controlled trials investigating the effects of CPAP and oral devices on blood pressure found that oral devices were as effective as a continuous positive pressure tool (CPAP) in lowering the blood pressure of patients suffering from OSA. Medical dental bedding, or MDSA, has been clinically proven to demonstrate conclusively in large, complex randomized controlled studies that CPAP and MAS are effective in treating sleep breathing disorders in subjects with AHI 5-30. CPAP is considered to be more effective, but randomized control evidence (as reviewed in 2013) suggests that splint may be effective in patients with varying degrees of obstructive sleep apnea. Both methods appear effective in relieving symptoms, increasing daytime sleepiness, quality of life and some aspects of neurobehavioral function, with less CPAP use than self-reported MAS use. More test subjects and their domestic spouses feel that CPAP is the most effective treatment, although MAS is easier to use. Nocturnal systemic hypertension has been shown to improve with MAS but not CPAP, although the changes are small.
Maps Mandibular advancement splint
Weakness
In a survey study of patients, many use was discontinued due to discomfort, lack of efficacy or switch to CPAP and frequent side effects including dry mouth, toothache, dental discomfort and jaw pain. Long-term use is not associated with temporamandibular disturbance but is associated with a permanent change in how the upper and lower teeth meet and the required equipment is about 0.8 repairs/relines per year. Some patients may find this device somewhat uncomfortable, although many patients feel less troublesome than CPAP mask treatments, so patients are more likely to wear them consistently and adhere to treatment CPAP manufacturers claim that devices improperly installed can cause teeth to shift from time to time time, as with CPAP, but cites no evidence to support this claim. Patients may pay about $ 1900 from the bag to secure this device, and, in the US, some health plans do not cover these costs. The high price for the prescribed tools has led to the proliferation of unproven lower-priced non-prescription tools and some sleeping specialists suggest it may be harmful.
Compliance with oral devices is strongly associated with patient reservations regarding the effects of the device on the teeth, the possibility of lack of efficacy, and discomfort.
See also
- Dental braces
- Oral and maxillofacial surgery
- Orthognathic Operation
- Prosthodontics
- Trismus
References
External links
Source of the article : Wikipedia
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