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What is a mandibular splint?
Mandibular splints (also called dental or oral appliances) are carefully constructed appliances worn in
the mouth during sleep. They hold your mandible (jawbone) forward from its usual resting position and
apart from your upper jaw (maxilla).
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What do mandibular splints do for snoring and obstructive sleep apnea?
When properly fitted and used, a splint holds the jawbone forward during sleep. The tongue is pulled
forward at the same time because it is attached to the jawbone. This traction on the tongue usually
enlarges the airway in the throat area and/or prevents collapse and accordingly, may reducing or
eliminating the snoring and sleep apnea.
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How effective are splints at treating snoring and obstructive sleep apnea?
A large-scale research study showed that about 64% of patient continued to use their splint after fitting
(FR Almeida, AA Lowe, S Tsuiki et al Journal of Clinical Sleep Medicine, Vol. 1, No. 2, 2005). The same study
showed that snoring was satisfactorily controlled in about 76% of patients who continued using the
splint. About 50% of patients with sleep apnea who use the device, can achieve normal breathing (Ng
AT dt al Effect of Oral Appliance Therapy on Upper Airway Collapsibility in Obstructive Sleep Apnea Am. J. Respir.
Crit. Care Med., July 15, 2003; 168(2): 238 - 241). Success is generally more frequent in milder cases of
sleep apnea. In women chances of success are worse if there is nasal blockage. In men, success
appears to be more frequent if apnea occurs mainly when sleeping on the back, if the jaw is pulled
further forward, and if there is no weight gain (M. Marklund, H. Stenlund, and K. A. Franklin Mandibular
Advancement Devices in 630 Men and Women With Obstructive Sleep Apnea and Snoring: Tolerability and Predictors
of Treatment Success Chest, April 1, 2004; 125(4): 1270 - 1278).
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Strategies for treatment success with your mandibular splint
Your body has to undergo several adjustments to get used a mandibular splint. The first hurdle is
getting used to sleeping with something fastened onto your teeth at night. If you have had braces or bite
guards or athletic mouth guards in the past you should have no problems with this aspect of the
adjustment. Others may take some time to get used to it. When first using the splint you begin with the
splint in most neutral (natural) position.
People vary widely in their initial ability to tolerate wearing the splint. Some are able to wear the splint
the entire first night without any adverse effects. Others take longer to adjust. Together, we need to
discover your pattern of adaptation and adjust our treatment plan accordingly. We can only progress
with your treatment plan as fast as your body allows. There is no realistic way to rush the process.
Those who are slow to adjust to the mandibular splint should adopt the following strategy to help your
body adjust.
1. If jaw pain or headache occurs early on during use of the mandibular splint (during or after the
first night of use) stop using the splint until the pain or headache resolves. You can take over-the-
counter doses of ibuprofen or acetaminophen to ease the discomfort. After the discomfort resolves, you
can resume wearing you’re mandibular splint for part of the night.
2. Begin by setting the alarm for one hour after bedtime. When the alarm goes off, remove your
mandibular splint and return to sleep. If this regimen is tolerated, set the alarm for two hours after
bedtime and so on. The key here is that you should not increase your wear-time until you are
comfortable with the mandibular splint at your last level of wear-time.
3. Once you have fully adjusted to wearing your mandibular splint through the night, you can begin
to advance your lower jaw (mandible) jaw) using the adjustment mechanism. This is the second
hurdle. The key to success is to advance the jaw a little at a time to help the body adapt to it. In this way,
we can achieve your treatment goals with a minimum of discomfort.
Snoring and sleep apnea are generally worsened by nasal congestion, the use of alcohol near
bedtime, and sleep deprivation; so try to avoid these. If you suffer from frequent nasal congestion,
check with us about medications for this and try wearing the BreatheRight™ nasal strips at night (you
can find these in most drug stores). Avoid alcohol near bedtime and be sure to get a full 7 to 8 hours of
sleep each night.
If you would like to experience an inexpensive 'do it yourself' mandibular splint you can purchase
one at www.snorban.com. This may give you a better idea as to whether you could tolerate and/or
benefit from such a device. This device is not as durable as one made by a professional, but will give
you an approximation of the feel and benefits.
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What are the likelihood of side effects from wearing a mandibular splint?
Short-term side effects of mandibular splints are usually described as mild and transient. Subjective
side effects include dry mouth, excessive salivation, tooth discomfort, muscle tenderness, and jaw
stiffness, but none of these symptoms appear to lead patients to abandon treatment according to a
large scale study. ( FR Almeida, AA Lowe, S Tsuiki et al Journal of Clinical Sleep Medicine, Vol. 1, No. 2, 2005 144)
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What are the reasons people stop using their mandibular splint?
Here are a list of reasons and incidence of side effects from a large scale study . Notice that in some of
this group, the apnea seemed to worsen with the appliance. ( FR Almeida, AA Lowe, S Tsuiki et al Journal of
Clinical Sleep Medicine, Vol. 1, No. 2, 2005)
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Reasons to discontinue use
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%
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Discomfort or cumbersome
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44.9
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No or little effect
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36.0
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Started Continuous Positive Airway Pressure
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23.6
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Mouth became too dry
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20.2
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Inconvenient to use
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18.0
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Painful
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15.7
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Dental Work Changed
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15.7
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Occlusion or jaw changes
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12.4
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Appliance doesn't fit anymore
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7.9
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Lost weight, apnea lessened
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7.9
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Claustrophobic
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5.6
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Could not swallow
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5.6
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Apnea worsened
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2.2
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Lost the appliance
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1.1
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How should I care for my mandibular splint?
Look over mandibular splint carefully each night before you use it. Discontinue using your mandibular
splint if you observe any separation of the materials, cracks, or other problems. I will need to examine it
to determine if repair is necessary. Clean your mandibular splint daily in cool water with a soft
toothbrush and any brand of toothpaste. Use a denture cleanser to remove stains. Store it in the clean
dry container provided for you. Keep your mandibular splint well away from children and pets (dogs will
use them as a chew toy!).
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When should I see my physician?
Keep your regularly scheduled appointments with me. In addition, if you develop pain in the gums or
unrelenting jaw pain you should come in for an examination. Your mandibular splint may need to be
altered or refitted.
You may note mild discomfort of the teeth within the first 48 hours of treatment. You may also note
some mild jaw muscle discomfort with initial use and possibly with each adjustment of the screw. You
may note excessive salivation (drooling during sleep) when first using the mandibular splint these side
effects are most often temporary and will improve with the passage of time.
You may notice that your bite (the way your teeth come together) is a little different the first thing in the
morning. This should not last more than an hour. Let me know if it is a problem for more than three
hours in the morning. You also may unknowingly remove your the mandibular splint during the night.
As you get used to the splint, this tendency gradually lessens.
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PRECAUTIONS
Temporomandibular joint (jaw joint) problems
Use of a mandibular splint such as the mandibular splint may place a certain amount of stress on your
jaw joint. If you have already had problems with pain or clicking or dislocation of your jaw joint you have
an increased risk of this problem. While it is not unusual for a mandibular splint user to have some
soreness of the jaw joint when first using the splint, a change in your bite or persistent or mandibular
splint severe pain are warning signs that your treatment plan needs reevaluation. Permanent damage
to your jaw joint may occur in such cases and require treatment by a specialist in this area. Stop using
your splint and call us if such problems arise.
Seizure disorders
Although use of a splint would help prevent biting of the tongue during seizure, it might also prevent the
optimal elimination of vomit from the mouth if this were to happen during a seizure. If you have a
seizure disorder, you must consult your treating physician for an opinion on the safety of such a device
in your case prior to using the splint.
Periodontal disease
Use of a mandibular splint may cause some pressure on your teeth. If you have periodontal disease or
loose teeth, you must consult with your dentist prior to using a splint for an opinion on the risk of
worsening such a condition.
Nausea or vomiting
Because of the risk of inhaling vomit (aspiration) while the mandibular splint is in place, you should not
use the mandibular splint if you feel nauseated or have been recently vomiting.
Abnormalities of your bite (the way your teeth fit together)
At the end of your successful treatment program with the Mandibular splint, you should consult your
personal dentist for their opinion regarding your bite. It is possible that the Mandibular splint could
cause a permanent bite change and this may not be healthy for the long term health of your teeth or
jaw. Your Dentist can advise you as to weather it is safe to continue Mandibular splint therapy with
these cautions in mind.
Other problems
You should not be fitted for a mandibular splint if you are currently undergoing treatment for a
temporomandibular joint disorder, have a severe overbite or under bite, dentures, loose dental fillings,
braces, or have a temporary crown in place. If there is any question about the current condition of your
teeth or dental work it is essential that you consult with your dentist prior to fitting with the mandibular
splint.
WARRANTY INFORMATION
Your mandibular splint (if furnished by Pacific Sleep Center) is guaranteed by the manufacturer not to
break while in normal use for 90 days following initial fitting of the device. If it breaks under normal use
conditions, during this period, schedule an appointment for the fitting of a warranty replacement. If the
splint breaks after the warranty period, we will check with your insurance company to obtain coverage
for fitting of a replacement splint and normal fees will apply. If the splint should break due to dropping it
or other such accident, you may check with your homeowners insurance company regarding coverage
but typically, neither the manufacturer nor health insurance will pay for a replacement due to accidental
breakage.
OTHER TREATMENT OPTIONS
Treatment with a mandibular splint is only one of the treatment options for snoring and obstructive
sleep apnea. Other treatments may be considered instead of mandibular splints if your situation calls
for it. Mandibular splints have also been used in combination with other treatments such as weight
loss, or surgery. If you have any questions or misgivings about your treatment choice, be sure to
discuss these with us.
NO TREATMENT
One of the options for snoring and sleep apnea is to undergo no treatment at all. You may want to
consider this if the risks of undergoing treatment seem to outweigh the benefits to you.
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OTHER SPLINT PROVIDERS
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Steve Carstensen, DDS
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Bellevue
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425-746-0021
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Jeff Donesky, DDS
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Bellevue
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425-646-6409
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Herb Gordon, DDS
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North Seattle
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206-363-8240
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Robert Horchover, DDS
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Seattle
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206-624-6992
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Jason Pehling, DDS
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North Seattle
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206-363-8240
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Cris Simmons, DDS
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Seattle
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206-682-3399
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Joseph Yousefian, DDS
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Bellevue
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425-562-2921
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Back to Sleep Apnea Treatments...
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