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In previous blogs, we discussed advancing the lower jaw forward as a means of opening up an individual’s airway to treat Obstructive Sleep Apnea.
When we sleep, especially on our backs, it is likely that our tongue and soft palate will fall backwards creating an obstruction in the back of our throats. In addition, the upper airway (the area behind the soft palate, tongue and larynx) is a collapsible tube that while asleep has great potential to do exactly that…collapse upon itself. Please see the last blog “The Upper Respiratory Tract and Mandibular Advancing Devices,” posted on April 14th, 2014.
The purpose of the Mandibular Advancing Device (MAD) is to mechanically bring the tongue, soft palate and upper part of the airway forward which will remove the obstruction caused by them falling back…The question is how does the MAD accomplish this?
Design of the MAD
There are quite a few design of MAD’s and the dentist’s role is to choose the one that is the best fit for the patient. Have you ever heard of the saying “ no one shoe fits all? Same concept…
Some of the factors that need to be considered are:
1. How many teeth are in each arch?
2. Are the teeth being held in firmly? I.e. are they on a good foundation?
3. What is the shape and height of the teeth like? Are they short and squat? Are they bulbous with undercuts?
4. Does the patient grind or brux their teeth?
5. Does the patient have a tongue thrust? I.e. thrust their tongue forward towards their front teeth?
There are many things to take into consideration. The points listed above are just a small sample of a magnitude of factors that come into play when deciding which appliance to use.
After fabricating an appropriate appliance that will best address the patient’s sleep apnea, we are ready to set a plan into action.
At first we give the patient the appliance and just ask them to wear it without any advancement of the lower jaw…..you can call it a ‘honeymoon’ period in which the patient is just getting used to the appliance. This is for a period of about one week.
After that we begin to advance the lower jaw…this is a slow process, perhaps a half to one millimeter per week (we often suggest half a millimeter two times per week).
The lower jaw is advanced slowly to ease the patient into the treatment and to reduce the number of side effects.
Quite a bit of control is handed over to the patient with respect to their appliance. In most cases the patient is the one who is adjusting and advancing their appliance, not the dentist. When they feel comfortable, they can set the appliance forward half a millimeter and then another and so on. Patients like having this degree of control.
The patient is monitored very closely through regular follow ups at the dentist. Our goal is to move the patient’s lower jaw forward with as few side effects as possible.
We will look at some common side effects in the next blog.
Yours in good health,
Dr. Robert Axelrad