Fellow Members -
Looking back on 2013, one of the most pivotal moments for the American Academy of Dental Sleep Medicine - and the field of dental sleep medicine - was the development of the first-ever empiric definition of an effective oral appliance for the treatment of sleep-disordered breathing, which is now available to review in the "Accepted Papers" section of the new Journal of Dental Sleep Medicine website at www.jdsm.org. I encourage you to read through the definition report to find out more about the research and rationale behind it as well as the rigorous creation process and collaborative effort that went into this industry milestone.
Having an empiric definition is a significant step forward for the dental sleep medicine industry as it paves the way for more consistency in research and clinical practice, and clarity for health insurers. Thank you to everyone who worked on this definition and to those who will join us in spreading its importance this year - you will all help us usher in a new chapter in our storied history of leadership.
B. Gail Demko, DMD, D.ABDSM
Definition of an Effective Oral Appliance for the Treatment of
Obstructive Sleep Apnea and Snoring
The purpose of an oral appliance is to treat obstructive sleep apnea (OSA), primary snoring, and associated symptoms. Oral appliances are intended to decrease the frequency and/or duration of apneas, hypopneas, respiratory effort related arousals (RERAs) and/or snoring events. Oral appliances have been demonstrated to improve nocturnal oxygenation as well as the adverse health and social consequences of OSA and snoring. Oral appliances are indicated for patients with mild to moderate OSA and primary snoring. Oral appliances are accepted therapy for patients with severe OSA who do not respond to or are unable or unwilling to tolerate positive airway pressure (PAP) therapies. Although oral appliances are typically used as a stand-alone therapy, they can serve as an adjunct to PAP therapy and/or other treatment modalities for the management of OSA.
For this definition oral appliances refer to mandibular advancement devices because they are the most effective and widely used in clinical practice. Accordingly the function of an oral appliance is to protrude and help stabilize the mandible in order to maintain a patent upper airway during sleep.
An oral appliance is custom fabricated using digital or physical impressions and models of an individual patient's oral structures. As such, it is not a primarily prefabricated item that is trimmed, bent, relined or otherwise modified. It is made of biocompatible materials and engages both the maxillary and mandibular arches. The oral appliance has a mechanism that allows the mandible to be advanced in increments of 1 mm or less with a protrusive adjustment range of at least 5 mm. In addition, reversal of the advancement must be possible. The protrusive setting must be verifiable. The appliance is suitable for placement and removal by the patient or caregiver. It maintains a stable retentive relationship to the teeth, implants or edentulous ridge and retains the prescribed setting during use. An oral appliance maintains its structural integrity over a minimum of 3 years.
This definition includes the key design features of effective oral appliances, is evidence based or, in the absence of evidence, is agreed upon using a modified RAND Appropriateness Method process. Its intent is not to replace clinical judgment but instead represents a compilation of the best currently available appliance design features.