Oral Appliance Therapy

Oral Appliance therapy involves the selection, design, fitting and use of a specially designed oral appliance that, when worn during sleep, maintains an opened, unobstructed airway in the throat. Oral appliances that treat snoring and obstructive sleep apnea are devices worn in the mouth, similar to orthodontic retainers or sports mouthguards. They have several advantages over other forms of therapy. Oral appliances are comfortable and easy to wear and care for. They are small and convenient, making them easy to carry with you when you travel. Treatment with oral appliances is reversible and non-invasive.

Oral appliance therapy is becoming recognized by the medical community as an effective treatment option in the management of sleep breathing disorders. Medical and dental researchers have joined together to evaluate and improve the outcome of treatment with oral appliances.

Oral appliances may be used alone or in combination with other means of treating OSA, including general health and weight management, surgery or nasal continuous air pressure (CPAP). Oral appliances work in several ways:

Oral appliance therapy can take from several weeks to several months to complete. Even after the intial phase of treatment is complete, we will continue to follow you to be sure that treatment remains successful and to evaluate the response of your teeth and jaws.

Our office is pleased to provide the following information about the type of oral appliance therapy we provide.

The Thornton Adjustable Positioner (TAP®) oral appliance is a Thortnton Adjustable Positionermandibular advancement device composed of two separate arches (maxillary and mandibular) containing an advancing mechanism which permits unlimited advancement of the lower jaw. The arches are custom fit to a patient's models. The advancing mechanism is engaged and the screw mechanism in the upper tray is then turned to advance the mandible until the patient begins to feel any discomfort in the temporomandibular joint or in the facial muscles (maximum mechanical protrusion which is an average of 2.5mm beyond maximum protrusion). The advancing screw is then turned back until patient is comfortable.

The Herbst Telescopic Appliance has been proven to be effective on chronic snoring and mild to moderate obstructive sleep apnea sufferers. This appliance allows patients to move laterally and vertically without disengaging the appliance. Also, if it is determined Herbstthat the initial position does not provide the anticipated relief of the condition, the mandible can easily be moved forward by two options of adjustability. The first option is traditional hardware with sets of 1,2 and 3 mm shims for advancing those increments only. The second being the Telescopic version allowing the clinician to advance in ¼ mm increments by making one full turn of the protrusion collar up to 6-8mm from the start position. The appliance can be fabricated from hard acrylic, thermoactive and soft materials and is tooth retained via friction grip or clasps.

The Herbst Appliance is a mandibular repositioner that has been in use many years for orthodontic and TMJ therapy prior to its modification for treatment of sleep disordered breathing.

The greatest advantage of the Herbst appliance is that it allows for very quick, easy and accurate mandibular protrusive adjustability. This is accomplished through simple manipulation of the rod/sleeve plunger mechanism. Vertical opening varies is 5 mm and there is limited freedom of movement for the mandible in a lateral direction. Bilateral interarch elastics are recommended to keep the jaw closed during sleep.

NOTE: Some clinicians feel that limited lateral movement of the lower jaw during appliance use is beneficial for TMJ comfort while others believe it is of no benefit. Also, some clinicians find compromised effectiveness if the mandible is allowed to drop down even as much as a millimeter during appliance use while others find no difference. These are both areas that require more scientific study. We are presently unaware of the precise effect of these parameters on appliance effectiveness.


The Tongue Retaining Device (TRD) is lab constructed of a flexible polyvinyl material adapted to the general contours of the teeth and dental arches. It does not depend on teeth for retention. Rather, the tongue is held forward by the negative pressure created in the vacuum bulb on the front of the appliance.

TRDThe appliance is available in four tongue extensions and with or without air way tubes for patients with compromised airway patency. It is constructed in conjunction with the Kel Gauge (described in another section of this program.)

Since the mandible is not rigidly or firmly held by the appliance, freedom of movement is possible during use. This would seem to make the TRD a good choice for the edentulous patient, the patient with periodontal disease and the patient with temporomandibular joint dysfunction.

There is ample research available documenting the effectiveness for treatment of snoring and OSA in certain patients.

NOTE: Mandibular repositioners have been successfully used in edentulous patients over dentures in certain cases where the dentures have had adequate retention. Mandibular repositioners have also been successfully used in patients with compromised periodontal status or TMJ function. In these cases, however, the clinician needs to be especially careful in design and follow up.

Norman Blumenstock, DDS, MAGD, D.AAPM, D.ABDSM
DentalSleepMedicine.info
8218 Wisconsin Avenue
Bethesda, Maryland 20814
20528 Boland Farm Road
Germantown, Maryland 20876
Ph: 301-922-1140
Fx: 877-571-0331
Email: DCDentalSleepMedicine@comcast.net
Web site: http://www.dentalsleepmedicine.info

Office Hours: Monday-Friday 9am to 5pm