In this blog, we explain how Leone’s Mandibular Advancement Device offers a higher level of comfort for the patient than many models on the market, and how anti snoring medicine is an underexplored, yet much needed treatment for many sufferers in the UK.
The British Orthodontic Society posted an online article this month outlining recommendations from Professor Johal, the BOS authority on Dental Sleep Medicine and Vice-President of the British Society of Dental Sleep Medicine. He states that dentists can play a significant role in the diagnosing and treating of patients who suffer from sleep related problems.
Dental professionals are being encouraged to routinely screen for sleep related problems and Obstructive Sleep Apnoea. With this, comes a new wave of interest from clinicians who wish to gain the knowledge of how to carry out a safe screening process for each patient, and if the patient qualifies, correctly prescribe the appropriate device.
In the article, Professor Johal says: “Managing patients with OSA is very much the domain of multi-disciplinary clinics, within which the dental profession now has an established role. We regularly see patients with more serious sleep-related problems but where the problems are milder, colleagues in general dental practice can manage their treatment.”
Who is suffering from Snoring and Obstructive Sleep Apnoea?
According to the British Snoring and Sleep Apnoea Association, 41.5 % - 15 million people in the UK suffer from snoring, and sufferers of Obstructive Sleep Apnoea (OSA) are estimated at about 1.5 million (1).
This presents an opportunity to offer a life-changing treatment, and even improve the personal relationships for many patients, as many couples may be sleeping in separate bedrooms as a result of the condition.
What are the symptoms of Obstructive Sleep Apnoea?
Symptoms reported by sufferers of snoring and OSA can range from headaches, excessive daytime sleepiness, irritability and depression (2). Untreated OSA has been linked with heart disease, stroke, type two diabetes, risk of motor vehicle accidents and impaired quality of life (2, 3).
What treatments are available for Snoring and Obstructive sleep apnoea?
Amongst the variety of treatment methods such as nasal dilators, oral appliances and CPAP machines, studies have shown that for mild to moderate Obstructive Sleep Apnoea (OSA) and snoring, a Mandibular Advancement Device is an effective treatment method (4). With this in mind, DB Lab Supplies have exclusively introduced two devices from Leone for the UK market.
The device postures the mandible forward, preventing the airwaves from narrowing and obstructing airflow.
Which are the most comfortable designs?
Following the manufacturer's research and development with leading sleep medicine experts, the most effective appliances were recognised to be the dorsal, and the telescopic. There was potential to enhance patient comfort and compliance in both – something which Leone have achieved. Both devices are easy to adjust and more comfortable than alternatives on the market - particularly due to the lateral movement.
The “Telescopic” device
The “Telescopic” device (above left) allows wider lateral and opening movements for patient comfort. Attention to detail ensures maximum safety, including the use of biocompatible stainless steel of the highest strength to ensure maximum durability, and a mushroom designed plug to eliminate disassembling from the tube component. The advancer screw is activated using the wrench which comes in each kit. The arrows marked on the arms allow for easy use; each ¼ activation produces a 0.1 mm advancement up to 7mm.
The “Forward” (dorsal) device
The “Forward” (dorsal) device (above right) is reported to be particularly comfortable as there is no attachment between upper and lower and therefore offers maximum lateral movement. The device features a dorsal “fin” or wings which are bonded to the posterior of the lower appliance on both sides. The upper part of the appliance features two advancing screws with a metallic body. When worn, the advancing screws on the upper make contact with the dorsal fins on the lower at the optimum 70 degree angle. This contact applies a gentle force to help posture the mandible forward, thus preventing the airwaves from narrowing and obstructing airflow. The advancing screw can be adjusted - each turn producing 0.1mm of movement to a maximum protrusion of 7mm.
Training for Laboratories
Your lab technician can book on the two day UK course led by Ed Payne, Senior Chief Instructor in Orthodontics at the Eastman Dental Institute. The course awards 12 hours verifiable CPD – giving dental technicians the knowledge and experience required to fabricate devices successfully. The first UK date is on the 13-14th July at the Eastman Dental Institute.
The BOS article posted also quotes sleep apnoea authority James Spencer, Postgraduate Dean in the Yorkshire and Humber region “The development of the face and jaw and the treatment of malocclusions with functional appliances is core knowledge for all orthodontists and for many of us an understanding of the causes and treatment of sleep apnoea. However, not all dental hospitals and acute hospital trusts treat patients with sleep-related problems so we welcome additional input from colleagues in primary care.”
Dental professionals who provide anti snoring oral appliances are certainly benefitting from a huge market demand. The figures show there is an opportunity for all dental professionals to make a difference to people’s lives. So if you aren’t catering for snorers already, now is the time to reconsider.
- British lung foundation OSA UK health economics report
- British Snoring & Sleep Apnoea Association
- Anika Ahrens, Colman McGrath, Urban Hägg; A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea, European Journal of Orthodontics, Volume 33, Issue 3, 1 June 2011, Pages 318–324,
- Durán-Cantolla, Joaquín et al. “Efficacy of Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea Syndrome: A Randomized Controlled Crossover Clinical Trial.” Medicina Oral, Patología Oral y Cirugía Bucal5 (2015): e605–e615. PMC. Web. 1 Mar. 2018.